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。     

羟乙基淀粉在卵巢过度刺激综合征中的应用8例分析

目的 观察羟乙基淀粉(贺斯)治疗卵巢过度刺激综合征(OHSS)的疗效.方法 8例卵巢过度刺激综合征患者单纯给予羟乙基淀粉并适时穿刺放腹水.结果 8例中、重度卵巢刺激综合征患者全部转归.结论 羟乙基淀粉有很好的扩容效果,可广泛的用于OHSS治疗,与白蛋白相比费用低廉,来源方便,更适宜临床应用.     

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.     

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。     

58例重度卵巢过度刺激综合征患者的护理

总结58例重度卵巢过度刺激综合征(OHSS)患者的护理经验.58例均发生在体外受精-胚胎移植超促排卵后,经心理护理,合理补液,以及穿刺引流腹水等对症治疗后治愈,无并发症发生.对OHSS高危险因素的患者.做好心理护理,指导患者选择全胚胎冷冻,能减轻重度OHSS的危害程度,减少治疗费用的支出;同时做好腹腔穿刺引流腹水等对症护理,及时给予出院指导.加强病情监测,能预防并发症的发生.使患者顺利渡过危险期.     

卵巢过度刺激综合征77例临床分析

目的：探讨多囊卵巢综合征（OHSS）治疗的临床特征和治疗方法。方法：回顾性分析77例OHSS住院患者的临床资料。结果：77例OHSS患者均发生在超促排卵周期的第9～22 d,其中50例患者发生在体外受精胚胎移植（IVF-ET）术后。经过监护、扩容、补液、注射黄体酮及腹腔、胸腔穿刺引流后,患者在6～43d内病情缓解并出院,77例患者妊娠47例,其中一例终止妊娠。结论：OHSS的治疗主要是对症支持治疗,严密监护OHSS的病情发展,扩容是治疗的关键,治疗严重的难以控制的OHSS,终止妊娠是最有效的手段。     

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-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OHSS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.     

B超诊断卵巢过度刺激征1例

患者,女性,26岁。因腹痛、腹胀2天入院。B超示:子宫前位,大小正常,左、右侧卵巢明显增大,大小分别为78.3mm×50.7mm,46.0mm×38.3mm,卵巢内示有多个卵泡,腹腔内中等量腹水(图1)。追问病史:患者于末次月经第5天服用克罗米酚促排卵。B超诊断:①卵巢过度刺激症;②腹水。临床按照B超的诊断给予补充血容量及白蛋白,抽腹水,预防电解质紊乱等治疗,患者痊愈。     

卵巢过度刺激综合征患者的临床观察及护理

目的：探讨卵巢过度刺激综合征(OHSS)患者的护理观察及措施。方法：对44例OHSS患者的基础护理以及心理支持方法进行分析总结。结果：44例OHSS患者的护理措施完善，心理护理方法得当，患者均康复出院。结论：专科护理及心理护理在OHSS的治疗中尤为重要，护士在严密观察病情变化，加强基础护理和专科护理的同时，有针对性地运用心理支持方法，可以有效地促进病人的康复。     

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。     

Identification of diuretic non-responders with poor long-term clinical outcomes: a 1-year follow-up of 176 non-azotaemic cirrhotic patients with moderate ascites

In cirrhosis, the development of ascites and the response to diuretics are determined by the RAAS (renin-angiotensin-aldosterone system) and renal sodium handling system. We hypothesized that SNPs (single nucleotide polymorphisms) affecting candidate genes in the RAAS and renal sodium handling pathway may influence initial diuretic responsiveness and affect clinical outcome in non-azotaemic cirrhotic patients with moderate ascites. We prospectively recruited 176 patients and 245 controls and determined their genetic polymorphisms for 24 SNPs of ten genes involved in the RAAS and renal sodium handling pathway. In cirrhotic patients with moderate ascites, multivariate analysis showed that diuretic unresponsiveness was predicted by a high basal plasma aldosterone level, by a high aldosterone/renin ratio and by specific risk genotypes of ACE (gene encoding angiotensin-converting enzyme), CYP11B2 (gene encoding aldosterone synthase) and ADDA (gene encoding α-adducin). This association between genetic polymorphisms and diuretic unresponsiveness was confirmed by an independent validation cohort. Notably, additive effects in relation to diuretic unresponsiveness were observed in cases where there was the simultaneous presence of the three risk genotypes. Among patients carrying any of the risk genotypes, more episodes of paracentesis and ascites-related readmission after 3 months of treatment, as well as a reduced 1-year survival rate, were observed. In addition to traditional predictors, our present study provides additional genetic and neurohormonal predictors that will help to identify diuretic non-responders among cirrhotic patients with moderate ascites. Among those carrying unfavourable risk genotypes, additional therapies, including paracentesis and albumin infusion, should be started as early as possible.     

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.     

中、重度卵巢过度刺激综合征31例临床分析

目的探讨卵巢过度刺激综合征(OHSS)的临床表现及相应的治疗对策。方法回顾分析本院发生的31例中、重度OHSS临床资料。结果OHSS绝大多数发生在促排卵治疗后,临床表现主要为腹胀、恶心、腹水、胸水、水肿、尿少、血液浓缩、低蛋白血症、氮质血症,经严密监护、输白蛋白或血浆扩容及放腹水等对症治疗后治愈。结论OHSS在严密监护下,经相应的对症治疗可治愈。     

超促排卵并发中、重度卵巢过度刺激综合征的护理

目的探讨超促排卵治疗过程中并发中、重度卵巢过度刺激综合征(ovarian hyper-stimulation syndrome,OHSS)的护理对策。方法回顾性总结2010年6月至2011年6月在接受体外受精-胚胎移植治疗的患者中,80例因超促排卵并发中、重度卵巢过度刺激综合征患者的临床资料及护理体会。结果 80例患者经积极治疗及护理后,均全部康复,其中32例获得妊娠、48例终止妊娠。结论中、重度卵巢过度刺激综合征患者的护理重点应包括预防性监测及护理、心理护理、饮食及用药护理、腹胀及腹痛的护理、腹水引流的护理及出院后指导等。     

腹水超滤浓缩回输治疗难治性腹水临床观察

目的观察腹水超滤浓缩回输治疗难治性腹水临床疗效。方法将43例肝硬化患者随机分为两组,对照组20例,给予卧床休息,限钠、水,输血浆、白蛋白,利尿,护肝和适当放腹水加输白蛋白等综合治疗。治疗组23例,仅给予基础护肝和配合腹水超滤浓缩回输仪,自体腹水浓缩后回输入腹腔。观察患者治疗前后症状、体征、体重、尿量、血浆蛋白、血钠、钾变化和平均住院日及住院费用情况。结果治疗组患者治疗后体重、尿量、白蛋白、血肌酐、血钠钾指标及平均住院日及住院费用优于对照组,差异有统计学意义(P<0.05)。结论腹水超滤浓缩回输治疗肝硬化腹水,疗效好、住院费用少,值得临床推广。     

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.     

腹水超滤浓缩回输术治疗肝硬化腹水临床分析

目的观察腹水超滤浓缩回输术治疗肝炎肝硬化顽固性腹水的临床疗效。方法将兰州大学附属白银医院2002年5月至2007年5月肝炎肝硬化合并腹水住院患者76例；随机分为对照组40例和治疗组36例。对照组给予腹腔穿刺放液治疗；治疗组采用腹水超滤浓缩回输治疗。比较两组治疗前后体质量、腹围、尿量的变化，检测电解质、尿素氮、肌酐、胆红素及血清白蛋白指标，并注意观察并发症情况。结果两组治疗后，治疗组在腹围、体质量方面较对照组明显改善（P〈0.05），治疗组24h尿量较对照组显著增加（P〈0．01）；同时，两组组在血清白蛋白、血清肌酐指标上比较有显著性差异（P〈0．01或P〈0.05），而尿素氮水平无显著性差异（P〉0.05）。治疗组显效率和总有效率均优于对照组，差异有显著性（P〈0.01）。治疗组并发症发生率低于对照组，差异有显著性（P〈0．05）。结论腹水超滤浓缩回输术是治疗肝硬化腹水的一种有效方法，具有操作简便、不良反应及并发症较少特点。     

卵巢过度刺激综合征的临床治疗与分析

目的 探讨卵巢过度刺激综合征(OHSS)的特征以及防治疗方法 .方法 对我院46例OHSS患者的临床资料采取回顾性分析的方法 .结果 经过治疗,所有患者症状均有所缓解,复查各项生化指标正常.结论 OHSS应高度重视和警惕,早期识别、相应的预防措施及对症支持治疗能减少OHSS发生,保护患者的生命安全.