中、重度卵巢过度刺激综合征219例临床分析

Clinical analysis for 219 cases of moderate and severe ovarian hyperstimulation syndrome

目的研究辅助生殖技术中卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的临床特点、治疗和预防。方法对安徽医科大学第一附属医院生殖中心2007年3月至2010年12月行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)和卵细胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)中发生中、重度OHSS的219例患者的临床资料进行回顾性分析。结果在219例患者中,OHSS发生率的为4.2%(219/5176),其中重度OHSS42例(19.2%),中度OHSS177例(80.8%)。早发组重度OHSS发生率(18例,8.2%)与晚发组(24例,11.0%)比较,差异有统计学意义(P<0.001);取卵后发生OHSS的时间为1～19d,早发组平均发生时间为(2.2±1.8)d,晚发组为(12.4±3.4)d(P<0.001)。主要表现为腹胀、恶心、呕吐和少量腹水患者占80.8%(177/219);合并胸水、少尿、血液浓缩、水电解质及酸碱平衡紊乱者占19.2%(42/219);仅1.4%(3/219)出现呼吸困难,均给予支持对症治疗后痊愈。住院治疗率31.5%(69/219),全胚胎冷冻患者住院率(8.7%,19/219)与非全胚胎冷冻(22.8%,50/219)比较,差异有统计学意义(P<0.05)。新鲜移植共124例,总妊娠数53例(42.7%,53/124),其中早发组33例(33.3%,33/99),晚发组20例(80%,20/25);多胎妊娠29例,早发组14例(14.1%,14/99),晚发组15例(60%,15/25)。新鲜移植妊娠率与全胚胎冷冻后冷冻胚胎移植妊娠率(44.4%,20/45)比较,差异无统计学意义(P>0.05);多胎妊娠的患者病程较长(P<0.05)。结论早发组与晚发组患者临床特征有较大差异。对有高危因素或早发OHSS患者行胚胎冷冻保存及冻融胚胎移植或单胚胎移植可有效的预防OHSS。

Objective To investigate the clinical characteristics,treatment and prevention of ovarian hyperstimulation syndrome（OHSS）in assisted reproduction techniques（ART）.Methods Clinical data of 219 moderate and severe OHSS cases who were received in vitro fertilization-embryo transfer（IVF-ET）or intracytoplasmic sperm injection（ICSI）in the First Affiliated Hospital of Anhui Medical University from March 2007 to December 2010,were analyzed retrospectively.Results OHSS occurred after controlled ovarian hyperstimulation treatment,the incidence was about 4.2%（219/5 176）.177（80.8%）were moderate OHSS and 42（19.2%）were severe OHSS.The distribution of severe OHSS patients between early group（18 cases,8.2%）and late group（24 cases,11.0%）was signifiant different（P0.001）.80.8%（177/219）patients had abdominal distension,nausea and ascites,19.2%（42/219）patients were manifested with pleural effusion,oliguria,hypoalbuminemia,electrolyte and acid-base disturbance,only 1.4%（3/219）patients had dyspnea.Total of 69（31.5%）patients hospitalized for treatment,19 cases were frozen embryos patients,50 cases were underwent fresh transplantation,the difference was significant（P0.05）.Among the 124 patients who received fresh transplantation,53（42.7%,53/124）pregnant,33（33.3%,33/99）of them were in early onset group and 20（80%,20/25）in late onset group;there were 29 cases with multiple births,14（14.1%,14/99）in early onset group and 15 cases in late group（60%,15/25）.45 patients received frozen embryos transplantation,the pregnant rate was 44.4%（20/45）.The pregnancy rate between fresh transplantation and frozen embryos trans plantation had no significant difference（P0.05）.Conclusions The clinical features of early and late onset group were quite different.Multiple pregnance was the risk factor of OHSS.Cryopreserving all embryos on the day of transfer or choose single embryo transfer can reduce the duration of OHSS symptoms effectively.