OBJECTIVE：To investigate t he effects of Baihe gujin decoction combined with Shenmai injection on therapeutic efficacy and related indexes in elderly patients with ventilator-associated pneumonia. METHODS ：A total of 75 elderly patients with ventilator-associated pneumonia who were admitted to the Intensive Care Unit （ICU）of Zhuji Hospital of TCM from Apr. 2018 to Oct. 2019 were included. They were randomly divided into control group ，Shenmai group ，Baihe gujin decoction+Shenmai group ， with 25 cases in each group. Control group was given conventional treatments as Piperacillin sodium tazobactam sodium injection 4.5 g，ivgtt，q8 h for anti-infective treatment+ Ambroxol hydrochloride injection 4 mL，iv，bid for expectorant+ Doxofylline injection 20 mL，qd for relieving spasm and asthma+maintaining water ，electrolyte and acid-base balance. Shenmai group was given Shenmai injection 100 mL，ivgtt，qd，on the basis of control group. Baihe gujin decoction+Shenmai group was given Baihe A101） gujin decoction 200 mL nasally ， morning and evening ，on m the basis of Shenmai group. Each group took 7 days as a course of treatment ，and the treatment was continued for 2 courses. Acute physiology and chronic health status （APACHE）Ⅱ score，C-reactive protein （CRP）in peripheral blood ，procalcitonin（PCT），bronchial CD 68 count were observed in 3 groups before and after treatment while the mechanical ventilation time ，hospitalization time in the ICU and ADR recorded. RESULTS：Before treatment ，there was no statistically significant difference in APACHE Ⅱ score，the levels of CRP and PCT ， bronchial CD 68 count among 3 groups（P＞0.05）. After 14 days of treatment ，APACHE Ⅱ score，CRP and PCT levels of all 3 groups were significantly lower than before treatment ；bronchial CD 68 count was significantly higher before treatment ，the order of bronchial CD 68 cell count was Baihe gujin decoction+Shenmai group ＞Shenmai group ＞control group （P＜0.05 or P＜0.01）；after 7 days of treatment ，the order of CRP and PCT levels was Baihe gujin decoction+Shenmai group ＜Shenmai group ＜control group （P＜0.05）；after 14 days of treatment ，there was no staistically significant difference in APACHE Ⅱ score，CRP and PCT levels among 3 groups（P＞0.05）. After treatment ，the order of mechanical ventilation time and ICU hospitalization time was Baihe gujin decoction + Shenmai group ＜Shenmai group ＜control group （P＜0.05 or P＜0.01）. There was no significant difference in the incidence of ADR among 3 groups（P＞0.05）. CONCLUSIONS ：Based on routine treatment ，Baihe gujin decoction combined with Shenmai injection can improve the immune function of lung macrophages in the elderly patients with ventilator-associated pneumonia，inhibite pulmonary inflammation progress ，reduce mechanical ventilation time ，shorten the length of hospital stay with good safety.