目的 探讨乌司他丁联合比阿培南治疗重症肺炎的临床疗效。方法 选取2015年5月-2017年5月在中国人民解放军第四军医大学第一附属医院治疗的重症肺炎患者90例，随机分为对照组（45例）和治疗组（45例）。对照组静脉注射注射用比阿培南，0.3 g加入生理盐水100 mL，1次/8 h；治疗组在对照组基础上静脉注射注射用乌司他丁，25万U加入生理盐水100 mL，2次/d。两组患者均治疗2周。评价两组患者临床疗效，同时比较治疗前后两组患者细菌清除率、临床症状改善情况、血清学指标和血清肺表面活性蛋白水平。结果 治疗后，对照组和治疗组总有效率分别为80.00%、95.56%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组患者细菌清除率为86.67%，明显高于对照组的63.33%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组的退热时间、肺部啰音消失时间和咳嗽消失时间均明显短于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者血清超敏C反应蛋白（hs-CRP）、降钙素（PCT）、白细胞介素-1β（IL-1β）和可溶性髓系细胞触发受体-1（sTREM-1）水平均显著降低（P<0.05）；且治疗组比对照组降低更明显（P<0.05）。治疗后，两组血清肺表面活性物质相关蛋白-A（SP-A）、肺表面活性物质相关蛋白-B（SP-B）、肺表面活性物质相关蛋白-C（SP-C）、肺表面活性物质相关蛋白-D（SP-D）水平均显著降低（P<0.05）；且治疗组患者血清肺表面活性蛋白水平明显低于对照组（P<0.05）。结论 乌司他丁联合比阿培南治疗重症肺炎可有效改善患者临床症状、降低机体炎症反应，改善血清肺表面活性蛋白，具有一定的临床推广应用价值。

Objective To investigate the clinical effects of ulinastatin combined with biapenem in treatment of severe pneumonia. Methods Patients (90 cases) with severe pneumonia in the First Affiliated Hospital of the Fourth Military Medical University from May 2015 to May 2017 were randomly divided into control (45 cases) and treatment (45 cases) groups. Patients in the control group were iv administered with Biapenem for injection, 0.3 g added into normal saline 100 mL, once every 8 h. Patients in the treatment group were iv administered with Ulinastatin for injection on the basis of the control group, 2.5×10⁴ units added into normal saline 100 mL, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the bacterial clearance rates, the improvement of clinical symptoms, serological indexes and serum pulmonary surfactant protein level in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 80.00% and 95.56%, respectively, and there were differences between two groups (P<0.05). After treatment, the bacterial clearance rates in the treatment group was 86.67%, which was significantly higher than 63.33% in the control group, and the difference was statistically significant between two groups (P<0.05). After treatment, the disappearance time of fever, pulmonary rale and cough in the treatment group was significantly shorter than that in the control group, with significant difference between two groups (P<0.05). After treatment, the hs-CRP, PCT, IL-1β, and sTREM-1 level in two groups was significantly decreased (P<0.05). And the decrease degree in the treatment group was more obvious than that the control group (P<0.05). After treatment, the SP-A, SP-B, SP-C and SP-D level in two groups was significantly decreased (P<0.05). And the serum pulmonary surfactant protein level in the treatment group was obviously lower than that the control group (P<0.05). Conclusion Ulinastatin combined with biapenem can effectively improve the clinical symptoms and reduce inflammatory reaction in treatment of severe pneumonia, and improve the serum surfactant protein, which has a certain clinical application value.