离子型和非离子型造影剂用于子宫输卵管造影的效果观察及护理

目的：探讨卵巢过度刺激综合征（OHSS）患者的护理方法。方法：对92例OHSS患者加强病情观察，给予心理护理、专科护理，积极治疗并发症。结果：本组86例治愈，可继续正常妊娠，6例终止妊娠，其中2例合并异位妊娠。结论：对OHSS患者给予精心护理，可控制OHSS进展，促进患者康复。     

中重度卵巢过度刺激综合征41例临床分析

目的:探讨中、重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的发病诱因、临床诊断与防治方法.方法:回顾性分析41例中、重度OHSS的患者的临床资料.结果:①年轻、体格偏瘦、多囊卵巢综合征、应用绒促性素行黄体支持治疗以及妊娠是OHSS的诱因;②合并妊娠的OHSS患者具有病程长、症状重、白蛋白应用剂量大的特点;③严密的监护、静脉滴注白蛋白扩容、防止血液浓缩为治疗OHSS的有效措施;对症状重者应予穿刺引流胸腔积液和腹水.结论:在应用促排卵药物的过程中,应注意预防OHSS的发生.对于中、重度OHSS患者应严密监护,及时扩容治疗.     

自然受孕后卵巢过度刺激综合征的诊治并文献复习

目的探讨少见类型卵巢过度刺激综合征(OHSS)的临床表现和处理方法。方法对1例早期自然妊娠发生OHSS的临床资料进行回顾性分析,并复习相关文献。结果本例患者因停经44d,腹胀4d入院,经保守对症治疗后腹胀仍未减轻,终止妊娠后症状减轻,2周后超声检查未见异常。结论自然妊娠也可导致OHSS,终止妊娠可能是最后采取的最有效的治疗手段,临床应防止误诊而实施不适当的手术干预。     

中重度卵巢过度刺激综合征27例临床分析

目的总结中重度卵巢过度刺激综合征(ovarian hypersitmulation syndorme,OHSS)的临床表现、发病机制及相应的治疗方法。方法回顾性分析27例中重度OHSS患者的临床资料。结果 OHSS均发生在超排卵治疗后,其中中度16例,重度11例,重度临床表现以张力性腹水、胸水表现为主,治疗重点为密切监测生命体征和各项生化指标、对症处理,27例均采用了白蛋白扩容、肝素钠皮下注射改善血液高凝状态,11例重度OHSS患者行腹腔穿刺,6例重度OHSS行胸腔穿刺,妊娠患者平均缓解时间较未妊娠患者长约16天。27名OHSS患者中获得临床妊娠24例,失败3例。结论防治OHSS的关键在于预防,一旦发生中重度OHSS,需严密观察和及时治疗,迟发型OHSS比早发型症状重。     

妊娠合并急性胰腺炎的临床分析

目的 探讨妊娠合并急性胰腺炎的临床特点及诊治经验.方法 对9例妊娠合并急性胰腺炎患者的临床资料进行回顾性分析.结果 妊娠合并急性胰腺炎多见于妊娠晚期,多为出血坏死型.9例患者中,4例轻症患者经保守治疗痊愈,其中2例中期妊娠患者治愈后,孕至足月正常分娩;2例晚期妊娠患者治疗期间顺产,母婴健康.5例重症患者中4例妊娠33～35+周,经基础治疗1～2 d后行剖宫产分娩,剖宫产术后对腹腔胰周冲洗并置管引流,其中1例行胆道引流术,母婴均存活；1例重症患者发生多器官功能衰竭,孕妇及胎儿死亡.结论 对妊娠合并急性胰腺炎患者做到早期诊断,加强监护,根据病情采取个体化综合治疗,适时终止妊娠是降低孕妇、胎儿病死率的关键.     

社区高血压患者社会支持状态调查及护理对策

目的探讨卵巢过度刺激综合征(OHSS)患者的护理方法.方法对92例OHSS患者加强病情观察,给予心理护理、专科护理,积极治疗并发症.结果本组86例治愈,可继续正常妊娠,6例终止妊娠,其中2例合并异位妊娠.结论对OHSS患者给予精心护理,可控制OHSS进展,促进患者康复.     

中重度卵巢过度刺激综合征90例临床分析

目的探讨辅助生殖技术中的卵巢过度刺激综合征(OHSS)的高危因素及临床监测与治疗。方法对四川省人民医院90例中、重度卵巢过度刺激综合征临床资料进行回顾性分析。结果 (1)OHSS发生的高危因素:年轻患者、多囊卵巢综合征、过多卵泡数目以及妊娠。(2)妊娠的OHSS患者与未妊娠患者的病程分别为(18.56±12.19)d及(8.28±3.21)d,临床治疗时间及病程明显延长;未妊娠与妊娠患者所使用清白蛋白量为(130.43±24.22)g及(257.39±64.35)g,妊娠患者症状重、清蛋白治疗用量大。(3)扩容及输注清蛋白是治疗OHSS的有效措施,严重患者穿刺引流胸腔积液和腹水可缓解症状。结论 OHSS是辅助生育技术控制性超排卵治疗引起的医源性并发症,应予以正确的防治。     

IVF-ET术后并发重度OHSS伴早期妊娠的观察及护理

观察体外受精-胚胎移植（IVF-ET）术后并发重度卵巢过度刺激综合征（OHSS）伴早期妊娠患者28例,针对症状给予相关护理,降低流产率,提高妊娠成功率,其中26例持续妊娠的患者虽然症状严重,但无终止妊娠的指标,在精心护理和治疗下,均已痊愈出院。     

卵巢过度刺激综合症的临床护理

目的 探讨体外受精-胚胎移植治疗周期中发生的重度卵巢过度刺激综合症的临床观察和护理。方法 对我院1991年至2004年2月共收治107例卵巢过度刺激综合症（OHSS）患者的护理进行分析总结。结果 102例OHSS患者治愈，可继续正常妊娠，5例须中止妊娠，其中有2例合并异位妊娠。结论 加强病情观察与专科护理，积极治疗并发症，可以有效地促进病人的康复。     

卵巢过度刺激综合征129例临床分析

目的：观察OHSS综合治疗的疗效和安全性。方法：OHSS的治疗主要是对症支持治疗。Ⅰ级的患者主要是严密观察水与解质的平衡和腹围的变化，停止使用任何促性腺激素药物，采用低右和白蛋白扩容治疗。Ⅱ～Ⅲ级患者增加白蛋白用量。必要时配合采用腹腔穿刺放液和人工流产术。结果：经过治疗。所以有的患者的症状均在7～48d内缓解。结论：OHSS的治疗主要是对症支持治疗，治疗严重的难以控制的OHSS，终上妊娠是最有效的手段。此外。要警惕宫外孕的发生。避免误诊。     

来曲唑与克罗米芬对多囊卵巢综合征患者促排卵效果观察

目的:探讨来曲唑与克罗米芬治疗女性不孕多囊卵巢综合征(PCOS)的临床疗效。方法:选择我院2010年9月~2012年8月收治的50例诊断为PCOS的女性不孕症患者,随机分为来曲唑组和克罗米芬组各25例,并进行排卵期护理宣教。结果:来曲唑组患者共完成26个周期的治疗,克罗米芬组患者共完成25个周期的治疗。两组患者卵泡成熟天数、子宫内膜厚度、优势卵泡数、成熟卵泡数、妊娠率和卵泡发育率差异均无统计学意义(P0.05),但来曲唑组的排卵率显著高于克罗米芬组(P0.05)。来曲唑组患者未出现异位妊娠和卵巢过度刺激综合征,克罗米芬组有1例发生卵巢过度刺激综合征。结论:来曲唑在治疗PCOS引起的女性不孕症中,可显著提高患者的排卵率。     

Emergency ultrasound diagnosis of ovarian hyperstimulation syndrome: case report

Background

Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to ovulation induction therapy. It is a known complication of ovarian stimulation in patients undergoing treatment for infertility. As assisted reproductive technology and the use of ovulation induction agents expands, it is likely that there will be more cases of OHSS presenting to the Emergency Department (ED).

Objectives

OHSS has a broad spectrum of clinical manifestations, from mild abdominal pain to severe cases where there is increased vascular permeability leading to significant fluid accumulation in body cavities and interstitial space. Severe cases may present to the ED with ascites, pericardial effusions, pleural effusions, and lower extremity edema. Through a case report, we review OHSS with an emphasis on early diagnosis by Emergency Physician (EP)-performed bedside ultrasonography.

Case Report

We present a case of a patient undergoing treatment for infertility who presented to the ED with shortness of breath and abdominal pain. The diagnosis of severe OHSS was made, largely based on EP-performed bedside ultrasonography showing peritoneal free fluid and bilateral pleural effusions, as well as multiple ovarian follicles.

Conclusions

This report reviews the pathophysiology of OHSS, its clinical features, and pertinent diagnostic and management issues. This report emphasizes the importance of early EP-performed bedside ultrasonography.     

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that is associated with modern techniques for in vitro fertilization. Extensive efforts have been made to understand the pathophysiology and to improve the management of this entity. The severe and life-threatening forms of the ovarian hyperstimulation syndrome are still challenging for critical care physicians. This article reviews the pathogenesis, epidemiology, classification, clinical manifestations, and complications of these forms of OHSS. The different therapeutic options currently available are reviewed, and a stepwise approach for the management of these patients is provided.     

Ovarian overstimulation syndrome: problem of intensive care

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication, the basis for which is a hyperergic uncontrolled ovarian response to gonadotropins in the ovulation stimulation cycles and assisted procreation programs. The clinical picture of OHSS is characterized by a broad spectrum of clinical and laboratory manifestations: increased vascular permeability resulting in the excess release of liquid into the third space and its storage with the development of hypovolemia, hemoconcentration, oliguria, hypoproteinemia, electrolyte imbalance, polyserositis; in severe cases, acute renal failure, thromboembolic events, and adult respiratory distress syndrome develop. The goal of treatment is to prevent the development of multiply organ dysfunctions. Its leading methods are infusion therapy with colloid-crystalloid solutions and anticoagulant therapy. Whether diuretics and other drugs are administered is under consideration. Indications for laparocentesis and peritoneal transudate evacuation are discussed. Complications requiring surgery are identified.     

Ovarian hyperstimulation syndrome: A review for emergency clinicians

IntroductionA great deal of literature has recently evaluated the prevention and management of ovarian hyperstimulation syndrome (OHSS) in the outpatient setting, but there remains a dearth of research evaluating OHSS in the emergency department (ED) and its management.ObjectiveThis narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature.DiscussionOHSS is an iatrogenic complication caused by an excessive response to controlled ovarian stimulation during assisted reproductive cycles (ART). OHSS complicates up to 30% of ART cycles, and many of these patients seek initial care in the ED. Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy. Emergency physicians will be faced with several complications including ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed, which improves patient outcomes. This review provides several guiding principles for management of OHSS and associated complications.ConclusionsOHSS occurs in up to 30% of IVF cycles and carries a high morbidity. Effective care of the OHSS patient begins with early diagnosis while evaluating for other diseases and complications. Understanding these complications and an approach to the management of OHSS is essential to optimizing patient care.     

Intensive care for ovarian hyperstimulation syndrome

The paper reviews the current data available in the literature on the pathophysiology, clinical presentation, and treatment of the ovarian hyperstimulation syndrome (OHSS). Today due to the intensive development of high assisted reproductive techniques (ART) using the current superovulation stimulation, the risk of OHSS grows steadily. The clinical symptoms of OHSS appear in the luteal phase of a cycle and in early pregnancy when most females have just left the in vitro fertilization centers. In this connection, physicians of many specialties, including obstetricians, gynecologists, and intensivists should know the clinical manifestations of this syndrome and can correctly render a medical aid. Disputable issues of inpatient therapy for OHSS and the specific features of infusion management and intensive care are discussed.     

超声对卵巢过度刺激综合征的诊断价值

目的探讨超声对卵巢过度刺激综合征的诊断价值.方法收集我院自1999年来诊治的7例卵巢过度刺激综合征病例进行回顾分析.结果 7例患者的卵巢增大,3例伴腹水,1例腹水伴胸水.结论超声是诊断卵巢过度刺激综合征的首选方法.     

Continuous ascitic recirculation in severe ovarian hyperstimulation syndrome

Massive ascites, hydrothorax, acute renal failure and thromboembolism are clinical manifestations of severe ovarian hyperstimulation syndrome (OHSS) which may complicate the induction of ovulation with exogenous gonadotrophins. We report a case of severe OHSS with ascites formation in excess of five litres per day. Massive ascites and bilateral pleural effusions resulted in respiratory failure. Continuous ascitic recirculation (AR) was commenced after repeated paracentesis and IV fluid therapy failed to improve the patient's condition. The procedure was undertaken for a total of 15 days and rapidly resulted in marked improvement of impaired respiratory function. Febrile episodes occurred on 3 occasions, but we did not observe coagulation disturbances or adverse haemodynamic effects. Continuous AR is a safe and effective treatment of complicated severe OHSS.     

B超介导下经阴道穿刺引流术在卵巢过度刺激综合征患者中的应用和护理

目的探讨对体外受精一胚胎移植术（IVF—ET）后卵巢过度刺激综合征（OHSS）出现张力性腹水需B超介导经阴道穿刺引流术患者的护理措施。方法回顾分析体外受精～胚胎移植周期中23例0HSS需行B超介导经阴道穿刺引流术患者的术前准备、术中配合和术后护理。结果23例患者手术均顺利进行，病情得以控制，未发生严重的心肺功能障碍和严重肝肾功能受损等并发症。结论B超介导经阴道穿刺引流术是治疗卵巢过度刺激综合征患者出现张力性腹水的有效方法。手术的成功取决于医生的技术，护士熟识手术步骤能更好地配合医生进行手术。术后饮食指导是患者治疗成功的重要环节。