超促排卵后卵巢过度刺激综合征并发迟发性颅内静脉窦血栓1例并文献复习

Late-onset cerebral venous and sinus thrombosis after ovarian hyperstimulation syndrome in in vitro fertilization:a case report and literature review

目的报道1例超促排卵后卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)并发迟发性颅内静脉窦血栓,并对OHSS并发血栓进行文献复习。方法经典长方案超促排卵,取卵后发生重度OHSS,给予补液、抗凝、纠正低白蛋白血症等对症治疗,症状好转2个月后出现颅内静脉窦血栓,经抗凝、抗血小板聚集、脱水减轻脑水肿、营养神经、改善脑循环等对症治疗。随后检测到蛋白C活性显示为45%,提示有血栓形成倾向,其为血栓高危人群。结果随访至今,患者出院后于当地医院继续降颅压及营养神经治疗,仍留有神经后遗症。结论 OHSS伴血栓形成是辅助生殖技术的罕见却极其严重的并发症,临床医生应高度警惕。此外,预防OHSS的发生是预防其并发血栓的关键因素。

Objective To report one case of late-onset cerebral venous and sinus thrombosis after ovarian hyperstimulation syndrome（OHSS） in in vitro fertilization and review the associated literatures. Methods After（classical） long protocol ovulation induction and oocyte retrieval, the patient was diagnosed with severe OHSS. So we corrected hypoalbuminemia, anti-inflammatory and the patient was almost recovery. However, the patient was diagnosed with late-onset cerebral venous after 2 months. Though we made thrombosis anticoagulation, antiplatelet aggregation, dehydration, improvement of cerebral circulation. The patient was not cured. After testing, the patient was observed in thrombosis high-risk（protein C activity was 45%）, suggesting the tendency of thrombosis. Results After discharge, the patient was followed up, and continued to reduce intracranial pressure and nutritional nerve treatment at the district hospital. Conclusion OHSS with thrombosis is a rare but serious complication, and we should pay more attention to it. In addition, prevention of OHSS is one of the key factors to prevent thrombosis.