70例中重度卵巢过度刺激综合征临床病例分析

发布时间：2018-03-04 16:43

  本文选题：卵巢过度刺激综合征　切入点：羟乙基淀粉　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:探讨卵巢过度刺激综合征(Ovarian Hyperstimulation Hyndrome,OHSS)的高危因素;分析妊娠、OHSS发生时间与中、重度OHSS相关性;以白蛋白为对照组,研究万汶对于中、重度OHSS的治疗效果,为OHSS临床观察、治疗提供依据。方法:选取2013年8月至2014年12月在吉林大学白求恩第一医院生殖妇科住院接受体外受精-胚胎移植(In Vitro Fertilizationembryotransfer,IVF-ET)的中、重度OHSS患者70例,采取Logistic回归分析法分析中、重度OHSS的高危因素。根据2009年Golan【1】等提出的诊断标准分为中度OHSS 34例和重度OHSS 36例;根据是否合并妊娠分为妊娠组11例和未妊娠组59例;根据发病时间分为早发型OHSS组54例和迟发型OHSS组16例。研究妊娠、OHSS发病时间与中、重度OHSS的相关性。根据治疗方式不同分为研究组35例和对照组35例。研究组给予静脉滴注万汶1 000毫升,1/日,连续5天;对照组给予静脉滴注白蛋白12.5克,1/日,连续5天。观察2组治疗前、治疗后5天血常规及肝功能的变化和治疗临床效果的比较,并进行统计学分析。结果:1一般资料:70例OHSS患者在年龄、体质量指数(Body Mass Index,BMI)、注射人绒毛促性腺激素(Human Chorionic Gonadotropin,HCG)日雌二醇(E2)值和穿刺卵泡数之间比较无统计学差异(p0.05)。Logistic回归分析结果显示:年龄和体质量指数为OHSS发生的保护因素(OR1);而注射HCG日E2值和取卵穿刺卵泡数为OHSS发生的危险因素(OR1)。2妊娠与中、重度OHSS的相关性70例OHSS患者中合并妊娠者11例,其中中度OHSS者1例(9%),重度OHSS者10例(91%);未合并妊娠者59例,其中中度OHSS者33例(56%),重度OHSS者26例(44%)。两者比较有统计学意义(p=0.004、p0.05)。3 OHSS发病时间与中、重度OHSS的相关性70例OHSS患者中早发型OHSS 54例,其中中度OHSS者33例(61%),重度OHSS者21例(39%);迟发型OHSS 16例,其中中度OHSS者1例(6%),重度OHSS者15例(94%)。两者比较有统计学差异(p=0.0001、p0.05)。4治疗措施70例中重度OHSS患者均给予白蛋白或万汶扩容等对症治疗,其中35例OHSS患者应用万汶1000毫升1次/日,连用5日;另外35例OHSS患者应用白蛋白12.5克1次/日,连用5日。34例中度OHSS患者中行腹腔穿刺术治疗的共1例(3%);36例重度OHSS患者中行腹腔穿刺术治疗的共15例(42%),其中1例(3%)重度OHSS合并胸水行胸腔穿刺术治疗。放腹水量最多的是4000毫升。5研究组与对照组之间比较5.1血常规指标:组间比较:治疗前2组白细胞计数和Hct值分别比较差异无统计学意义(p0.05);治疗后5天,万汶组白细胞计数、Hct值显著低于白蛋白组,但差异无统计学意义(p0.05)。组内比较:2组治疗后5天的白细胞计数、血Hct值均低于治疗前,差异有统计学意义(p0.05)。5.2肝功能指标:组间比较:治疗前2组谷丙转氨酶和谷草转氨酶指标分别比较差异无统计学意义(p0.05);治疗后5天2组谷丙转氨酶和谷草转氨酶指标分别比较差异无统计学意义(p0.05)。组内比较:2组治疗后5天谷丙转氨酶和谷草转氨酶指标较治疗前均无明显变化,差异无统计学差异(p0.05)。5.3临床疗效:治疗后5天,研究组治疗有效率是85.7%;对照组治疗有效率是80%,但2组比较无统计学意义(p0.05)。结论:1患者年龄过小、低BMI、注射HCG日E2值过高和取卵穿刺卵泡数过多是OHSS发生的高危因素。2妊娠可以加重OHSS严重程度。3迟发型OHSS患者临床症状较早发型OHSS患者症状严重。4在中、重度OHSS患者治疗上万汶和白蛋白都有扩容的作用,且作用效果相似。与白蛋白相比,万汶副反应发生率低、轻微、价格便宜且使用安全,是成为OHSS扩容治疗首选。
[Abstract]:Objective: To investigate the ovarian hyperstimulation syndrome (Ovarian Hyperstimulation, Hyndrome, OHSS) the risk factors; analysis of pregnancy, and the time of occurrence of OHSS in severe OHSS associated with albumin; control group of voluven for severe OHSS, OHSS treatment, clinical observation, provide the basis for treatment. Methods: August 2013 to December 2014 in IVF and reproductive hospital the first hospital of Jilin University Bethune (In Vitro, Fertilizationembryotransfer, IVF-ET) in 70 patients with severe OHSS, adopt Logistic regression analysis, the risk factors of severe OHSS. According to the 2009 Golan [1] and other diagnostic criteria proposed are divided into 34 cases of moderate OHSS and 36 cases of severe OHSS; according to whether the pregnancy of 11 cases were divided into pregnancy group and non pregnancy group 59 cases; according to the onset time divided into early-onset type 54 cases in group OHSS and delayed OHS S group of 16 cases of pregnancy. The onset of OHSS, and in the correlation of severe OHSS. The patients were divided into study group of 35 cases and 35 cases in the control group. The study group received intravenous infusion of voluven 1000 ml, 1/ days, 5 consecutive days; the control group was given intravenous infusion of albumin 12.5 grams, 1/ on 5 consecutive days. To observe the 2 groups before treatment, compared the clinical effect changes 5 days in blood and liver function of the treatment and after treatment, and statistical analysis. Results: 1 general information: 70 cases of OHSS patients in age, body mass index (Body Mass, Index, BMI), human chorionic gonadotropin injection gland hormone (Human Chorionic Gonadotropin, HCG), estradiol (E2) value and puncture follicle number had no significant difference (P0.05).Logistic regression analysis showed that age and body mass index as the protective factors of OHSS (OR1); and on the day of HCG injection E2 and egg follicle number for OHSS occurrence of puncture dangerous 闄╁洜绱，

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