取卵术后脑水肿1例报道与文献回顾

Brain edema after oocyte retrieval:a case report and literature review

目的探讨控制性超促排卵(controlled ovarian hyperstimulation,COH)和经阴道超声引导下卵巢穿刺取卵术后脑水肿发生机制和治疗方法。方法回顾分析1例COH和取卵术后脑水肿诊疗经过并进行文献复习。结果患者采用卵泡期长效长方案促排卵后获卵30枚,因卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)予羟乙基淀粉500 mL扩容。取卵术后8 h突发烦躁、意识模糊、呕吐,血生化指标检查示低钠血症,经阴道彩色超声检查示双侧卵巢增大,内见多个囊肿;头颅CT示脑水肿。高渗盐和甘露醇治疗12 h后患者生命体征平稳、症状缓解。取卵术后第5天因腹腔积液行超声引导下穿刺放腹水。取卵术后第7天因血浆D-二聚体升高予低分子肝素抗凝、预防血栓。2周后患者痊愈出院。结论COH和取卵术后脑水肿发生率低,但其症状重且可能危及生命。低钠血症可能是此患者脑水肿的主要原因。

Objective To investigate the mechanism,treatment and prevention of brain edema after controlled ovarian hyperstimulation(COH)and transvaginal ovarian puncture and oocyte retrieval.Methods A retrospective clinical study and literature review were performed to analyze one patient who was diagnosed as having brain edema after COH and transvaginal ovarian puncture and oocyte retrieval.Results After long acting gonadotropin-releasing hormone analogue(GnRH-a)COH protocol,30 oocytes were obtained.Hydroxyethyl starch 500 mL was given to treat ovarian hyperstimulation syndrome(OHSS)after oocyte retrieval.The patient had sudden irritability,blurred consciousness and vomiting at the 8th hour after oocyte retrieval.The examinations showed hyponatremia and brain edema.The patient relived after mannitol and hypertonic saline treatment.On the 5th day after oocyte retrieval,the patient performed paracentesis guided by ultrasound due to seroperitoneum.Low molecular weight heparin was applied to prevent thrombosis after the flare up of serum D-Dimer on the 7th day.The patient recovered and discharged after 2 weeks.Conclusion The incidence of brain edema after COH and transvaginal ovarian puncture and oocyte retrieval was very low.However,the symptoms may be severe and may be life-threatening.