Objective To determine the risk factors for acute lung injury（ALI） early after orthotopic liver transplantation.Methods The perioperative clinical data of all 275 patients who had undergone orthotopic liver transplantation were analysed retrospectively.Several statistically significant risk factors were screened out with univarite analysis，then independent risk factors were determined with multivariate stepwise logistic regression analysis.Results Of the all 275 patients，the morbidity of ALI was 9.8% with a mortality of 22.2%.Univariate analysis showed that the occurrence of ALI was associated with preoperative infection，severe hepatitis，renal dysfunction，massive blood transfusion in operation，long non-hepatic period and long cold ischemic time.Multivarite stepwise logistic regression analysis revealed that the independent risk factors for ALI were massive blood transfusion in operation（OR=12.12，95%CI 0.958-25.364），longer non-hepatic period（OR=1.23，95%CI 1.034-1.410） and longer cold ischemic time（OR=22.35，95%CI 1.266-43.421）.Conclusion Massive blood transfusion in operation，long non-hepatic period and long cold ischemic time were independent risk factors for ALI early after orthotopic liver transplantation.
Objective To investigate the effects of high dose ambroxol on patients with acute lung injury（ALI） after liver transplantation.Methods Thirty patients with ALI after liver transplantation were divided randomly into an ambroxol group and a control group.On the base of routine treatment，the patients were treated by intravenous infusion with high dose ambroxol of 15 mg/kg once a day for 7 days in the ambroxol group and with normal saline of same volume in the control group.The arterial blood gas analysis was performed and IL-1，IL-10 and TNF-α were measured before and 1 day，3 day and 7 day after the treatment.Length of stay in ICU were recorded and death rate in one year were followed-up.Results After the 1 days，3 days and 7 days of treatment，PaO2 and PaO2/FiO2 were improved in both groups with more significant improvement in the ambroxol group（Plt;0.05）.Before treatment，no differences of IL-1，IL-10 and TNF-α level were found between the two groups.But the level of IL-1 and TNF-α decreased significantly in the ambroxol group compared with the control group after 1 day treatment，and no differences were found after 3 day and 7 day.The level of IL-10 increased in both groups，but significantly in the ambroxol group after 1 day.The lenght of ICU stay in the ambroxol group was shorter than that in the control group[（8.2±5.6）d vs（11.4±6.5）d，Plt;0.05].Two died in the ambroxol group and 3 in the control group with no significant difference.Conclusion High dose ambroxol can improve blood gas exchange and decrease the lenght of ICU stay in ALI patients after liver transplantation，through its inhibitory effects on inflammatory response by down-regulation of IL-1，TNF-α and up-regulation of IL-10.