应用全面质量管理体系运转法降低辅助生殖技术刺激周期中重度卵巢过度刺激综合征发生率

Application of total quality management system methods to reduce the incidence of moderate and severe ovarian hyperstimulation syndrome in assisted reproductive technology cycles

目的探讨应用全面质量管理体系运转法的PDCA循环管理工具是否能降低中重度卵巢过度刺激综合征(OHSS)的发生率。方法 2017年上半年应用PDCA循环法实施一系列干预措施,比较开展PDCA前(2016年1~6月)、后(2017年1~6月)辅助生殖技术(ART)刺激周期患者的临床资料。结果患者平均年龄、体质量指数(BMI)、基础卵泡刺激素(FSH)、基础促黄体生成素(LH)、基础雌二醇(E2)、平均促性腺激素(Gn)使用时间、Gn用量在PDCA开展前、后差异均无统计学意义。开展PDCA后中重度OHSS患者的血抗苗勒管激素(AMH)、基础窦卵泡数、人绒毛膜促性腺激素(h CG)注射日血E2水平明显高于PDCA前(P=0.00、P=0.00、P=0.03)。PDCA后中重度OHSS发生率(1.2%)、新鲜周期胚胎移植率(54.5%)、迟发型OHSS发生率(54.5%)较PDCA前明显下降(2.1%、86.0%、82.5%,P=0.01、P=0.00、P=0.01),PDCA后氯米芬(CC)温和刺激促排卵方案比率(45.5%)、全部胚胎冷冻率(45.5%)明显增加(17.5%、14.0%,P=0.01、P=0.00)。达菲林触发排卵比率、正常受精率、卵裂率较PDCA前无明显增加。结论应用PDCA循环,实施一系列防止中重度OHSS发生的措施,可降低ART刺激周期中重度OHSS发生率。

Objective To explore whether the application of PDCA cycle management tools can reduce the incidence of moderate and severe ovarian hyperstimulation syndrome （OHSS）. Methods Based on PDCA cycle management tools, some interventions were performed in patients in assisted reproductive technology （ART） stimulation cycles. The data of the patients were compared before （from January to June 2016） and after （from January to June 2017） PDCA. Results In both groups before and after PDCA cycle, there were no significant differences in patients＇ age, body mass index （BMI）, the level of basal follicle stimulating hormone （FSH）, luteinizing hormone （LH） and estradiol （E2）, average duration of gonadotropin （Gn） used, Gn consumption. After PDCA cycle, the incidence of moderate and severe OHSS （1.2%）, the embryo transplantation rate （54.5%）, the late-onset OHSS rate （54.5%） were significantly reduced compared with before PDCA cycle （2.1%, 86.0%, 82.5%; P=0.01, P=O.O0, P=0.01）. After PDCA cycle, the rates of clomiphene citrate （CC） mild-stimulation protocol （45.5%） and all embryos-freezing cycles （45.5%） were significantly increased （17.5%, 14.0%; e=0.01, P=0.00）. There were no significant differences in the incidence of severe OHSS, the Diphereline trigger rate, 2 pronucleus （PN） fertilization rate, and cleavage rate. Conclusion With using PDCA management cycle, a series of interventions for prevention OHSS had been done to reduce the incidence of moderate and severe OHSS rates in ART cycles.