中、重度卵巢过度刺激综合征45例临床分析

Clinical analysis of 45 cases with moderate and severeovarian hyperstimulation syndrome

目的:总结体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)过程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:回顾性分析我院生殖中心2010年1月至2014年10月行IVF-ET中发生的中、重度OHSS而进行住院治疗的45例患者的临床资料。结果:45例研究对象中,ET妊娠组28例,未ET组17例,中度OHSS患者31例,重度OHSS患者14例。ET妊娠组重度OHSS发生率42.86%(12/28)与未ET组11.76%(2/17)比较,差异有统计学意义(P<0.05)。ET妊娠组的住院时间、腹穿率、白蛋白使用量均高于未ET组,差异均有统计学意义(P<0.05)。ET妊娠组,1例重度OHSS患者并发锁骨下静脉血栓,低分子肝素抗凝治疗效果良好。结论:在促排卵药物的应用过程中,应注意预防OHSS的发生,对有高危因素OHSS患者可行胚胎冷冻保存。对于中、重度OHSS患者应严密监护治疗。

Objectives： To investigate the clinical characteristics,therapy and prevention of ovarian hyperstimulation syndrome（ OHSS） in vitro fertilization- embryo transfer（ IVF- ET）. Methods： Data of 45 cases of moderate and severe OHSS after IVF- ET from January 2010 to October 2014 in Peking University First Hospital were analyzed retrospectively. Results： 45 cases were divided into ET- pregnancy group（ n = 28） and non- ET group（ n = 17）. There were 31 cases of moderate OHSS and 14 cases of severe OHSS. The occurrence rate of severe OHSS was（ 42. 86%,12 /28） in ET- pregnancy group and（ 11. 76%,2 /17） in non- ET group. The differ-ence was statistically significant（ P〈 0. 05）. The total course of OHSS,the rate of abdominocentesis and the dose of albumin in ET- pregnancy group were significantly higher than these of non- ET group（ P〈 0. 05）. In ET-pregnancy group,one severe OHSS patient complicated with subclavian vein thrombosis got a good therapeutic effect of low molecular weight heparin. Conclusion： We should pay attention to prevent the occurrence of OHSS when enhancing ovulation. Cryopreserving all embryos is an effective choice for patients with high- risk factor of OHSS. Intensive care is necessary in the treatment of moderate to severe OHSS patients.