万汶用于重度卵巢过度刺激综合征并发胸腹腔积液预防及治疗中的疗效分析

Analysis on curative effect of Voluven used for prevention and treatment of severe ovarian hyperstimulation syndrome combined with pleural effusion and seroperitoneum

目的：探讨重度卵巢过度刺激综合征（OHSS）并发胸腹腔积液患者采用万汶进行预防及治疗的临床疗效。方法：将该院2010年7月-2012年8月行体外受精-胚胎移植（IVF-ET）治疗的OHSS高危患者184例,共184个治疗周期,随机分成口服强的松组（A组：61个周期）、静脉滴注万汶组（B组：62个周期）、强的松与万汶合用组（C组：61个周期）;对3组高危患者重度OHSS及相关指标的发生率进行统计分析,对3组中出现的重度OHSS并发胸腹腔积液患者分别采用右旋糖酐联合白蛋白进行保守治疗（治疗组1）、万汶保守治疗组（治疗组2）、早期进行胸腹腔积液抽吸治疗（治疗组3）;比较3组患者治疗后血生化相关指标及住院时间等指标的差异。结果：A组成功妊娠28例,B组成功妊娠24例,C组成功妊娠29例;B组患者的总周期OHSS发生率、移植周期OHSS发生率、妊娠周期OHSS发生率均显著高于A组、C组患者且差异具有统计学意义（P〈0.05）,A组与C组总周期OHSS发生率、移植周期OHSS发生率、妊娠周期OHSS发生率比较差异均不具有统计学意义（P〉0.05）。在采用对高危患者进行预防治疗措施后,整个周期中28例患者出现重度OHSS患者合并胸腹腔积液采用3种不同的治疗方法,结果：3个治疗组在出院时尿素氮、肌酐、总蛋白、白蛋白、钾、钠均达到出院水平,3组患者尿素氮、肌酐、总蛋白、白蛋白、钾、钠治疗前比较差异均不具有统计学意义（P〉0.05）,治疗后3组在总蛋白、白蛋白水平上治疗组1要优于其他两组且差异具有统计学意义（P〈0.05）。3组患者在治疗住院时间、住院费用上比较差异均具有统计学意义（P〈0.05）,治疗组1的住院时间及费用均显著高于其他两组且差异均具有统计学意义（P〈0.05）。结论：对IVF-ET治疗的OHSS高危患者采用强的松与万汶合用对OHSS发生的预防效果优于单用万汶,同时对于重度OHSS患者的治疗应尽早进行胸腹腔积液抽吸治疗。

Objective： To explore the clinical efficacy of Voluven used for prevention and treatment of severe ovarian hyperstimulation syndrome （OHSS） combined with pleural effusion and seroperitoneum. Methods： A total of 184 high risk OHSS patients （184 cycles） treated by in vitro fertilization and embryo transfer （ IVF - ET） in the hospital from July 2010 to August 2012 were randomly divided into group A （oral administration of prednisone, 61 cycles） , group B （intravenous drip of Voluven, 62 cycles） and group C （prednisone combined with Voluven, 61 cycles） ; the incidence rates of OHSS and related indexes in the three groups were analyzed statistically; the patients with severe OHSS combined with pleural effusion and seroperitoneum in the three groups were treated with conservative treatment by dextranum combined with albumin （ treatment one group）, conservative treatment by Voluven （ treatment two group） and early aspiration therapy of pleural effusion and seroperitoneum （treatment three group） , respectively; the related blood biochemical indexes and hospitalization times in the three groups were compared. Results： In group A, group B and group C, 28, 24 and 29 patients got pregnancy successfully, respectively; the incidence rates of OHSS during the total cycle, transfer cycle and pregnancy cycle in group B were statistically significantly higher than those in group A and group C （ P 〈 0. 05 ）, there was no statistically significant difference in the incidence rates of OHSS during the total cycle, transfer cycle and pregnancy cycle between group A and group C （ P 〉 0. 05 ） . After taking preventive measures among the high risk patients, 28 patients with severe OHSS combined with pleural effusion and seroperitoneum during the whole cycle were treated with three different methods, the levels of urea nitrogen, creatinine, total protein, albumin, potassium and sodium in these patients in the three treatment groups leaving the hospital reached the criteria of discharging from hospital, there was no statistically significant difference in the levels of urea nitrogen, creatinine, total protein, albumin, potassium and sodium before treatment among the three treatment groups （ P 〉 0.05 ） ; after treatment, the levels of total protein and albumin in treatment one group were statistically significantly higher than those in treatment two group and treatment three group （ P 〈 0.05 ） . There were statistically significant differences in the hospitalization time and costs among the three treatment groups （ P 〈 0.05 ）, the hospitalization time and cost in treatment one group were statistically significantly higher than those in treatment two group and treatment three group （ P 〈 0. 05 ） . Conclusion： The preventive effect of prednisone combined with Voluven for occurrence of OHSS in high risk OHSS patients treated with IVF - ET is superior to simple Voluven, aspiration therapy of pleural effusion and seroperitoneum should be taken early for severe OHSS patients.