促超排卵的卵巢过度刺激临床分析

Clinical analysis of ovarian hyperstimulation syndrome

目的 :为了避免和减少卵巢过度刺激综合征 (OHSS)的发生 ,有效地提高排卵率和妊娠率。方法 :选择促超排卵治疗的 6 47例发生 OHSS的资料进行总结分析 ,于月经或激素撤血的第 3～ 5天开始用克罗米酚 (cc) /绝经期促性腺激素(HMG)或卵泡激素 (FSH) ,cc每日 10 0 mg连服 5天 ,HMG或 FSH每日 75 u连用 5天 ,第 8～ 10天 B超测卵泡 ,当主卵泡直径在 1.5 cm以上 ,每日量不变 ,若在 1.1cm以下 ,增至每日 15 0 u至直径达 2～ 2 .3cm,然后根据卵泡大小用 HCG的剂量。当卵巢直径 <5 cm用 HCG10 0 0 0 u肌注 ,卵巢直径在 5～ 5 .9cm用 HCG6 0 0 0～ 10 0 0 0 U,卵巢直径≥ 6 cm时不用 HCG,改用其他方法诱导排卵。结果 :妊娠率 42 .35 % (2 74/ 6 47) ,OHSS发生率 13.6 % (88/ 6 47)。结论 :强调严格掌握超排卵治疗的指征、方法和剂量 ,加强排卵和内分泌的监测 ,可有效地提高排卵和妊娠率 ,降低 OHSS发生率 ,中西医结合加上适当放腹水可有效地控制 OHSS的发展。

Objective:To avoid and reduce the incidence of ovarian hyperstimulation syndrome(OHSS), increase the ovulation rate and pregnancy rate(PR.) Methods: The medical records of all OHSS patients after ovulation induction were reviewed. Clomiphene Citrate(CC)/HMG or FSH were given during3~5 days after menstruation or hormone withdrawal bleeding. CC was 100mg/d, HMG or FSH was 75u/d, 5 days. The size of dominant follicles was detected by B-ultrasound in 8~10th days after induction: When the diameter was>1.5cm, the dosage was unchanged;<1.1cm, HMG or FSH was added up to 15ou/d until the diameter of ovarian reached 2~2.3cm: The dosage of HCG varied with the diameter of varian:<5cm, 10000u, muscle Injection; 5~5.9cm, 6000~10000u;≥6cm,stopped HCG and used other medicine. Results: The PR was 42.35%(274/647), the incidence of OHSS was 13.6%(88/647), of which 10.21%(66/647) were mild, 3.4%(22/647) were moderate and severe. Conclusion: Controlling strictly the treatment signs、application methods and dosage of ovarian inductin and monitored the ovulation、hormone of patients was not olny able to increase the ovulation rate and PR, but also decrease the incidence of OHSS. It is a feasible treatment for OHSS to combinae TCM and western mdeicine with drawing off hydroperitonia. \ \