葡萄糖酸钙与万汶对预防卵巢过度刺激综合征的随机对照研究

Voluven versus Calcium Gluconate for the prevention of ovarian hyperstimulation syndrome:aprospective,randomized controlled study

目的探讨葡萄糖酸钙与万汶在预防体外受精-胚胎移植时促排卵产生的卵巢过度刺激综合征(OHSS)中的作用。方法应用前瞻性随机对照研究将OHSS高危患者分为三组,Ⅰ组50例,Ⅱ组51例,于取卵后分别静点10%葡萄糖酸钙10ml、6%万汶1 000ml作为预防性治疗组,Ⅲ组49例未予任何治疗作为对照组,取卵日起连续用药3d,监测用药前后卵巢大小与血常规,观察各组治疗后的可移植胚胎人数、临床妊娠率及发生重度OHSS的患者比率。结果三组患者可移植胚胎人数差异无统计学意义(P>0.05)。万汶治疗前后卵巢体积增大最小,但差异无统计学意义(P>0.05);HCT增加同样最低,与其他两组比较差异有统计学意义(P<0.05)。三组重度OHSS发病率差异无统计学意义(P>0.05),早发型OHSS发病率三组相近,晚发型OHSS均发生于葡萄糖酸钙组。妊娠率三组间差异有统计学意义(P<0.05),在葡萄糖酸钙组最高,万汶组最低。结论高反应患者预防性应用葡萄糖酸钙与万汶并未减少重度OHSS的发生,但是万汶的应用降低了高反应患者的血液浓缩状态,葡萄糖酸钙的应用可能促进了妊娠率的提高。

Objective To assess the effectiveness of 6 % hydroxyethyle starch （Voluven） and calcium glu- conate at the time of oocyte retrieval for preventing severe OHSS at high -- risk patients in an in--vitro fertilization programme. Methods This is a prospective, randomized and placebo -- controlled study. There were 50 patients in calcium gluconate group , 51 in voluven group and 49 in control group. The ovarian size was measured on the day of hCG administration, oocyte collection and embryo transfer. The blood routine was measured on the same days. The number of transferred patients, embryos transferred, pregnancies and severe OHSS patients were observed in the study. Results No significantly difference of the number of transferred patients , embryos transferred , and severe OHSS patients was found in the three groups （P~ 0.05）. The number of pregnant patients was highest in calcium gluconate group, lowest in voluven group, there were significantly difference in the three groups （P^0.05）. Although there was no significant difference of the ovarian enlargement in the three groups on the day of embryo transfer and the day of hCG administration （P^0. 05） , it was lower in voluven group than that in the other groups. And the increasing of HCT was also the lowest in voluven group, there were significantly difference in the three groups （P^0. 05）. The number of early severe OHSS patients was similar in the three groups, but three patients of late severe OHSS were all in calcium gluconate group. Conclusion Administration of voluven and calcium gluconate did not avoid the development of severe OHSS in high - risk patients, but infused treatment of voluven may help to decrease pachyhemia, calcium gluconate maybe help to increase pregnancy.