探讨乙型病毒性肝炎（乙肝）后肝硬化患者的肝功能状况对顺阿曲库铵麻醉诱导过程中肌松效应的影响。

回顾性分析2011年4月至2013年2月在中山大学附属第三医院麻醉科全身麻醉下行上腹部手术的55例乙肝后肝硬化患者临床资料。根据肝功能Child-Pugh分级将患者分为A级组（32例）和B级组（23例）。A级组男19例，女13例；年龄（43±8）岁。B级组男12例，女11例；年龄（45±8）岁。所有患者均签署知情同意书，符合医学伦理学规定。两组患者均给予咪达唑仑0.05 mg/kg、异丙酚1.5 mg/kg、芬太尼4 μg/kg和顺阿曲库铵0.15 mg/kg静脉注射进行麻醉诱导。采用TOF-Watch SX加速度肌松监测仪记录两组患者使用顺阿曲库铵后的肌松效应，包括肌松起效时间、4个成串刺激（TOF）无反应时期、25%TOF恢复时间、50%TOF恢复时间、75%TOF恢复时间、肌松恢复指数，并评估气管插管条件。两组计量资料的比较采用t检验，两组计数资料的比较采用χ²检验。

两组患者气管插管条件均为优或良，差异无统计学意义（χ²=0.15，P>0.05）。与B级组比较，A级组的肌松起效时间、TOF无反应期、25%TOF恢复时间、50%TOF恢复时间和75%TOF恢复时间较短，A级组的肌松恢复指数较低，但差异均无统计学意义（t=1.24，1.04，0.97，1.96，1.41，1.34；P>0.05）。

顺阿曲库铵应用于肝功能Child-Pugh分级为A级和B级的乙肝后肝硬化患者时，其气管插管条件与肌松效应均不受肝功能分级的影响，临床应用时无需调整剂量。

To investigate the impact of liver function on muscle-relaxant effect of cisatracurium in the anesthesia induction in patients with hepatitis B cirrhosis.

Clinical data of 55 patients with hepatitis B cirrhosis who received upper abdomen surgery under general anesthesia from April 2011 to February 2013 in Department of Anesthesiology, the Third Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. According to liver function Child-Pugh grade, the patients were divided into two groups: grade-A group [n=32; 19 males, 13 females; (43±8) years old], grade-B group [n=23; 12 males,11 females; (45±8) years old]. The informed consents of all patients were obtained and the ethical committee approval was received. Anesthesia was induced with intravenous midazolam (0.05 mg/kg), propofol (1.5 mg/kg), fentanyl (4 μg/kg) and cisatracurium (0.15 mg/kg) in patients of two groups. The muscle-relaxant effect in patients of two groups after use of cisatracurium, including the onset time of muscle relaxation, period of no-response to train-of-four stimulation (TOF), recovery time of 25%TOF, 50%TOF,75%TOF, and muscle relaxation recovery indexes were recorded by accelerating muscle relaxation monitor TOF-Watch SX, and the tracheal intubation condition was assessed. The measurement data were compared by t test and enumeration data were compared by Chi-square test.

The tracheal intubation condition in patients of two groups were both excellent or good and no significant difference was observed between two groups (χ²=0.15; P>0.05). Compared with grade-B group, the onset time of muscle relaxation, period of no-response to TOF, recovery time of 25%TOF, 50%TOF, 75%TOF were shorter in grade-A group, whose muscle relaxation recovery indexes was lower. But there was no significant difference(t=1.24, 1.04, 0.97, 1.96, 1.41, 1.34; P>0.05).

The tracheal intubation condition and muscle-relaxant effect are not affected by liver function Child-Pugh grade when cisatracurium is administered in patients with hepatitis B cirrhosis of Child-Pugh grade-A or B. There is no need to adjust the dose when cisatracurium is used in clinic.