目的 研究谷氨酰胺聯(lián)合比阿培南對老年重癥肺炎患者血清肺表面活性蛋白的影響。方法 選擇2012年1月—2017年12月在西安市第四醫(yī)院進(jìn)行診治的232例老年重癥肺炎患者，隨機(jī)分為兩組。對照組靜脈注射比阿培南，觀察組聯(lián)合靜脈滴注谷氨酰胺。兩組均治療7 d。比較兩組的住院時間、臨床癥狀改善時間、血清肺表面活性蛋白水平和肺功能。結(jié)果 觀察組的有效率明顯高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組的咳嗽消失時間、體溫恢復(fù)正常時間、平均住院時間以及肺部X線吸收改善時間均明顯短于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療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）水平均明顯升高，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組明顯高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療后的FEV1、FVC、MEF25、PEF以及MWV50均明顯升高，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組明顯高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 谷氨酰胺聯(lián)合比阿培南對老年重癥肺炎患者具有較好的治療效果，其機(jī)制可能與升高血清肺表面活性蛋白水平，增強(qiáng)氣道局部防御以及免疫調(diào)節(jié)功能相關(guān)。

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.