重度卵巢过度刺激综合征合并大量胸腔积液23例临床分析

Clinical analysis of large pleurul effusion of 23 patients with severe ovarian hyperstimulation syndrome

目的探讨重度卵巢过度刺激综合征（OHSS）合并大量胸腔积液患者的临床特点和相关合并症。方法对重度OHSS合并大量胸腔积液并做抽液治疗的23例患者的临床资料进行回顾性分析。结果23例42次胸腔积液检查，有21例40次（95％）检测为渗出液，2例2次为漏出液；14例做了血气分析，均为呼吸性碱中毒，8例（35％）吸氧状态下合并低氧血症；20例（87％）血液黏稠度增高，3例正常；21例（91％）凝血功能正常，2例凝血功能亢进；红细胞压积增高18例（78％），正常5例；低蛋白血症者17例（74％）；低血钾症者16例（70％）；雌二醇为14651～25500pmol／L；天冬氨酸氨基转移酶升高16例（70％），丙氨酸氨基转移酶升高15例（65％）；肾功能均正常。结论重度OHSS合并胸腔积液其性质基本属渗出性，蛋白定量不很高，细胞分类以中性粒细胞为主；易出现血液黏稠度和红细胞压积增高，但凝血功能基本正常；易合并呼吸性碱中毒、低氧血症、低蛋白血症、低钾血症及肝功能受损。全部患者血清雌二醇水平明显增高。

Objective To explore the character and related complication of large pleural effusion of patients with severe ovarian hyperstimulation syndrome（OHSS）. Method Retrospective analysis of clinical materials was carried out in 23 cases which thoracocentesis was done because of large pleural effusion and OHSS from 1990 to 2005. Results Of 42 pleural effusion detection（2 thoracocentosis was done in 19 cases）, 40 （21 cases, 95% ） were exudation and 2 （2 cases） were transudation. The results of blood gas analysis of 14 cases were respiratory alkalosis and hypoxemia was diagnosed in 8 cases （35%） inhaling oxygen. Plasma viscosity of 20 cases（87%） increased and 3 cases were normal. Thromboxane function of 21 cases （91%） was normal and anticoagulated blood function of 2 cases increased. Hematocrit of 18 cases （78%） increased and 5 cases were normal,17 cases （74%） were diagnosed as hypoproteinemia, 16 cases （70%） were hypokalemia,estradiol was 14 651 -25 200 pmol/L,aspartate aminotransferase of 16 cases （70%） increased and alanine aminotransferase of 15 cases （65%） increased, renal insufficiency was not found. Conclusions Most of large pleural effusion of patients with OHSS are exudation,quantitative determination of protein is not very high, neutrophile granulocyte is predominant. Increased plasma viscosity and hematocrit are frequent, but thremboxane function abnormality is scarce. Respiratory alkalosis,hypexemia,hypoproteinemia,hypokalemia and liver function impairment are common. Blood serum estradiol levels of all patients increase obviously, thrombosis, renal failure and acute respiratory distress syndrome are not discoverable.