卵巢过度刺激综合征并发急性动静脉血栓及出血性脑梗死1例并文献复习

Ovarian hyperstimulation syndrome complicating acute arteriovenous thrombosis and hemorrhagic cerebral infarction in a case and literature review

目的探讨卵巢过度刺激综合征(OHSS)并发急性重症血栓的诊治思路。方法回顾性分析2018年10月该院收治的1例OHSS患者的临床资料,患者为26岁女性,因丈夫无精症行卵胞浆内单精子显微注射治疗,超促排卵取卵后24h出现严重恶心、呕吐,伴腹部胀痛,迅速进展为双侧上、下肢疼痛,乏力,头痛,失语,紧急入院抢救,行头颅磁共振成像、外周血管与腹部及心脏超声、血常规、凝血,以及肝、肾功能等检查,给予抗炎、抗凝、抗血小板聚集、扩容、补液、穿刺放腹水、营养神经、卵圆孔未闭封堵术及康复训练等一系列治疗。随访6个月。结果经系列检查最终诊断为早发型重度OHSS,并发急性动静脉混合血栓及出血性脑梗死,卵圆孔未闭。目前患者生活自理,肢体活动自如,话语连续性好,语速稍偏慢,诊断为轻微神经后遗症。结论应重视OHSS患者极早期出现严重动静脉血栓。按OHSS的发生、发展和转归进行分期及分阶段序贯治疗,有助于建立早发型OHSS并发急性重症血栓较为规范的诊治路径,促进疾病的迅速转归,改善患者的预后。

Objective To explore the diagnosis and treatment thinking of ovarian hyperstimulation syndrome(OHSS) complicating acute severe thrombosis.Methods The clinical data in one patient with OHSS treated in this hospital in October 2018 were retrospectively analyzed.The patient was a female aged 26 years old and conducted the intracytoplasmic single sperm microinjection therapy due to her husband with azoospermia.At 24 h after superovulation and egg collection,the patient appeared severe nausea,vomiting,accompanying abdominal distending pain,rapidly developed to bilateral upper and lower extremities pain,lacking in strength,head ache and aphasia,then the patient conducted emergency admission for rescue.The examinations such as cranial MRI,ultrasound of peripheral vessels,abdomen and heart,blood routine,blood coagulation,liver and renal function were performed.The series treatments such as anti-inflammation,anti-coagulation,anti-platelet aggregation,dilation,fluid infusion,puncture and discharging ascites,trophic nerve and patent foramen ovale closure were performed.The follow up lasted for 6 months.Results The patient was eventually diagnosed as early onset severe OHSS complicating acute mixed arteriovenous thrombosis,hemorrhagic cerebral infarction and patent foramen ovale.At present the patient took care of oneself in daily life,with freely body movement,good discourse continuity and slightly slow speech rate,and was diagnosed as mild neurological sequela.Conclusion Should pay attention to the appearance of severe arteriovenous thrombosis in OHSS patients.Conducting the staging and grading sequential therapy according to the occurrence,development and outcome of OHSS is conducive to establish the relatively normalized diagnosis and treatment pathway for early onset severe OHSS complicating acute severe thrombosis,promote the rapid prognosis of the disease and improve the prognosis of the patients.