目的 探討烏司他丁聯(lián)合比阿培南治療重癥肺炎的臨床療效。方法 選取2015年5月-2017年5月在中國人民解放軍第四軍醫(yī)大學(xué)第一附屬醫(yī)院治療的重癥肺炎患者90例，隨機(jī)分為對(duì)照組（45例）和治療組（45例）。對(duì)照組靜脈注射注射用比阿培南，0.3 g加入生理鹽水100 mL，1次/8 h；治療組在對(duì)照組基礎(chǔ)上靜脈注射注射用烏司他丁，25萬U加入生理鹽水100 mL，2次/d。兩組患者均治療2周。評(píng)價(jià)兩組患者臨床療效，同時(shí)比較治療前后兩組患者細(xì)菌清除率、臨床癥狀改善情況、血清學(xué)指標(biāo)和血清肺表面活性蛋白水平。結(jié)果 治療后，對(duì)照組和治療組總有效率分別為80.00%、95.56%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組患者細(xì)菌清除率為86.67%，明顯高于對(duì)照組的63.33%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組的退熱時(shí)間、肺部啰音消失時(shí)間和咳嗽消失時(shí)間均明顯短于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者血清超敏C反應(yīng)蛋白（hs-CRP）、降鈣素（PCT）、白細(xì)胞介素-1β（IL-1β）和可溶性髓系細(xì)胞觸發(fā)受體-1（sTREM-1）水平均顯著降低（P<0.05）；且治療組比對(duì)照組降低更明顯（P<0.05）。治療后，兩組血清肺表面活性物質(zhì)相關(guān)蛋白-A（SP-A）、肺表面活性物質(zhì)相關(guān)蛋白-B（SP-B）、肺表面活性物質(zhì)相關(guān)蛋白-C（SP-C）、肺表面活性物質(zhì)相關(guān)蛋白-D（SP-D）水平均顯著降低（P<0.05）；且治療組患者血清肺表面活性蛋白水平明顯低于對(duì)照組（P<0.05）。結(jié)論 烏司他丁聯(lián)合比阿培南治療重癥肺炎可有效改善患者臨床癥狀、降低機(jī)體炎癥反應(yīng)，改善血清肺表面活性蛋白，具有一定的臨床推廣應(yīng)用價(jià)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.