多囊卵巢综合征排卵障碍82例促排卵临床分析

Clinical outcome analysis of ovulation induction in 82 patients with polycystic ovarian syndrome

目的探讨多囊卵巢综合征（polycystic ovary syndrome,PCOS）为调整月经在妇科门诊促排卵的安全性、有效性。方法选取2015年4月至2017年4月西城区展览路医院和北京大学人民医院妇科门诊以不规律出血为主诉就诊,有生育要求的PCOS患者82例作为研究对象。观察其促排卵的用药及剂量、监测指标、扳机时机、月经恢复情况、妊娠率、不良反应发生率等。结果 82例PCOS患者中促排卵后临床妊娠率20.00%（34/170）,月经正常率91.17%（155/170）,不良反应发生率为7.05%（12/170）,其中恶心3例,呕吐2例,肝功能异常2例,黄素化囊肿2例,轻度卵巢过度刺激综合征3例,均自行缓解。妊娠是否成功与指导同房日或h CG日优势卵泡最大径线≥2.0 cm（P=0.001,OR=10.507,95%CI：2.650-41.658）、透明（P=0.001,OR=8.749,95%CI：2.530-30.261）、子宫内膜厚度≥7 mm（P=0.008,OR=9.347,95%CI：1.796-48.635）及A型子宫内膜（P=0.044,OR=2.917,95%CI：1.029-8.269）相关;与卵泡张力关系不大,与是否可见卵丘无关（P=0.227）。结论伴不规律出血的多囊卵巢综合征患者在妇科门诊开展促排卵治疗安全、有效。在促排卵超声监测时掌握优势卵泡大小、透亮度及子宫内膜厚度、形态与妊娠是否成功相关。

Objective To study the efficacy and safety of adjusting the menstrual cycle to promote ovulation in treatment of patients with polycystic ovarian syndrome（PCOS） in the primary level hospitals. Methods 82 PCOS patients, difficult to get pregnant for irregular menstrual cycle, were treated and selected as observation subject at gynecological clinics in Beijing Zhanlanlu Hospital and Beijing University People＇s Hospital from April 2015 to August 2017. The dosage, dosage, monitoring index, trigger timing, menstrual recovery, pregnancy rate and incidence of adverse reactions were observed Results For 82 cases of PCOS patients, who accepted ovarian stimulation treatment, the clinical pregnancy rate was 20.00%（34/170）, the normal menstrual rate was 91.17%（155/170）, and the incidence of adverse reactions was 7.05%（12/170, 3 cases of nausea, 2 cases of vomiting, 2 cases of abnormal liver function, 2 case of luteinized cyst, and 3 cases of mild ovarian hyper-stimulation,the symptoms were all relieved gradually. Getting pregnant or not was closely related to the following factors： the dominant follicle diameter being 2.0 cm and above（P =0.001, OR =10.507, 95%CI ：2.650 - 41.658）, the transparency（P =0.008,OR =9.347, 95% CI ：1.796 - 48.635）; the endometrial thickness greater than or equal to 7 mm（P=0.008, OR=9.347, 95% CI：1.796-48.635） and being type A endometrium（P =0.044, OR =2.917, 95% CI ：1.029-8.269）. It has little to do with follicular tension and has nothing to do with the presence or absence of the oocyst（P=0.227）. Conclusions For these PCOS patients suffered from abnormal menstruation, the curative effect of ovarian stimulation treatment is obvious and it is quite safe, and the pregnancy rate is closely related the dominant follicle diameter, its transparency, the endometrial thickness and its morphology while conducting ultrasonic monitoring of follicular growth.