目的 研究谷氨酰胺联合比阿培南对老年重症肺炎患者血清肺表面活性蛋白的影响。方法 选择2012年1月—2017年12月在西安市第四医院进行诊治的232例老年重症肺炎患者，随机分为两组。对照组静脉注射比阿培南，观察组联合静脉滴注谷氨酰胺。两组均治疗7 d。比较两组的住院时间、临床症状改善时间、血清肺表面活性蛋白水平和肺功能。结果 观察组的有效率明显高于对照组，差异有统计学意义（P<0.05）。观察组的咳嗽消失时间、体温恢复正常时间、平均住院时间以及肺部X线吸收改善时间均明显短于对照组，差异有统计学意义（P<0.05）。两组治疗后的血清肺表面活性蛋白A（SP-A）以及肺表面活性蛋白D（SP-D）水平均明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组明显高于对照组，差异有统计学意义（P<0.05）。两组治疗后的FEV1、FVC、MEF25、PEF以及MWV50均明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组明显高于对照组，差异有统计学意义（P<0.05）。结论 谷氨酰胺联合比阿培南对老年重症肺炎患者具有较好的治疗效果，其机制可能与升高血清肺表面活性蛋白水平，增强气道局部防御以及免疫调节功能相关。

Objective To study the effect of glutamine combined with biapenem on serum surfactant protein in elderly patients with severe pneumonia.Methods Selected 232 cases of patients with severe pneumonia who were treated in our hospital from January 2013 to December 2017, divided into two groups randomly. The control group was intravenously injected with biapenem, and the observation group was given glutamine.Results After treatment, the effective rate of the observation group was significantly higher control group (P<0.05). The cough disappearance time, the recovery time of body temperature, the average hospitalization time and the improvement time of pulmonary X-ray absorption in the observation group were significantly shorter than those in the control group (P<0.05). The serum SP-D and SP-A levels of the two groups increased significantly after treatment (P<0.05), and the observation group was more obvious (P<0.05). After treatment, FEV1, FVC, MEF25, PEF and MWV50 in the two groups were significantly increased (P<0.05), and the observation group was more significant (P<0.05). Conclusion The combination of glutamine and biapenem has a better therapeutic effect on the elderly patients with severe pneumonia. The mechanism may be related to increasing the level of serum lung surface active protein, enhancing the local defense of the airway and the function of immunoregulation.