舒适护理在重度卵巢过度刺激综合征中的应用

目的：探讨舒适护理在重度卵巢过度刺激综合征患者中的应用效果。方法对137例重度卵巢过度刺激综合征患者在护理过程采用舒适护理模式。结果患者住院治疗期间生理、心理、社会舒适方面均得到改善,获得较高舒适感,满意度调查为94.9%。结论舒适护理在重度卵巢过度刺激综合征中的应用意义重大,体现了人性化护理,推动了护理服务质量的提高,同时改善了患者治疗过程的舒适度,提高的护理服务的满意度。     

体外受精-胚胎移植治疗PCOS不孕分析

目的评价体外受精-胚胎移植（IVF-ET）治疗多囊卵巢综合征（PCOS）伴不孕的疗效。方法对2002年5月至2006年4月在本中心行IVF-ET或ICSI的PCOS患者资料回顾分析。A组为PCOS患者29周期,B组（对照组）为同期输卵管阻塞性不孕患者155周期。结果A组获卵数、胚胎数显著多于B组（P〈0.01）,OHSS发生率和移植取消率显著高于B组（P〈0.05）;A组年龄、促排卵药总量、优质胚胎率显著低于B组（P〈0.01）;两组不孕年限、HCG日E2水平、刺激时间、受精率、妊娠率、移植日内膜厚度均无显著差异。结论PCOS患者行IVF/ICSI-ET治疗时Gn用量少,获卵数多,胚胎数多,但优质胚胎率低;OHSS发生高危,取消移植率高;临床妊娠率、受精率与输卵管阻塞性不孕患者无显著差异。对于PCOS患者,IVF/ICSI-ET可以有效助孕。     

卵巢过度刺激综合征10例治疗体会

目的总结卵巢过度刺激综合征的治疗.方法回顾分析10例卵巢过度刺激综合征(以后简称OHSS)的临床资料.结果OHSS经过严密监护输白蛋白或血浆,扩容及放腹水等对症治疗后可治愈.结论OHSS在严密监护下,经过相应的对症治疗可治愈.     

卵巢过度刺激综合征36例临床分析

目的探讨卵巢过度刺激综合征(OHSS)的临床特征和治疗方法.方法对36例OHSS的临床资料进行回顾分析.结果 OHSS全部是发生在超促排卵周期的10～23d.经过监护、扩容、补液、利尿、糖皮质激素、黄体酮、腹腔、胸腔穿刺引流效果满意.结论严密监护OHSS的病情发展,扩容是治疗的关键,适量补液,控制腹水、胸水的穿刺引流.预防,警惕发生OHSS的高危因素,超促排卵时注意个体差异和卵巢的敏感性.     

卵巢过度刺激综合征的预测及预防

卵巢过度刺激综合征（OHSS）是一种医源性疾病,常发生于控制性超排卵（COH）病人,OHSS的发生率约5％-10％,严重OHSS发生率约1．4％。OHSS不仅影响妊娠成功率,甚至危及生命。该综合征的发病机制尚未阐明,目前只能对症处理和支持治疗,因此预防和及时发现是治疗的关键。本文就近年来OHSS的预测及预防的研究进展做一综述。     

卵巢过度刺激综合征的基因组学研究进展

卵巢过度刺激综合征（OHSS）是辅助生殖技术中最严重的医源性并发症之一。在控制性促排卵过程中,部分患者发生OHSS,影响辅助生殖治疗的临床结局,增加患者心理和经济负担,严重者危及患者生命安全。目前OHSS的发病机制尚不明确。因此,解析OHSS发病机制的研究对于临床预防和治疗有重大指导意义。近年来基因组学在OHSS研究中取得一定进展,部分研究显示DNA、RNA与OHSS的发生有关。本文就近年来与发生OHSS相关的基因组学研究进展作一综述,系统阐述OHSS发病相关的基因组学如何影响、介导OHSS的发生,然而,这些基因对OHSS的贡献仍然太小,需要重复性研究进一步证实,为OHSS的预防和治疗提供理论基础。     

多囊卵巢综合征合并胰岛素抵抗对体外受精-胚胎移植临床结局的影响

目的分析多囊卵巢综合征(PCOS)患者进行体外受精-胚胎移植(IVF-ET)时,胰岛素抵抗与临床结局的关系。方法选择PCOS患者181例为实验组(A组),将合并胰岛素抵抗的分为A1组,不合并胰岛素抵抗的分为A2组;月经周期规则且无胰岛素抵抗的输卵管性不孕(均为双侧输卵管梗阻)患者138例作为对照组(B组)。三组患者均采用经典长方案进行体外受精-胚胎移植(IVF-ET),比较各组间年龄、体重指数、AMH、性激素水平、Gn天数、Gn用量、HCG日内膜厚度、HCG日E2值、HCG日P值、获卵数、优质胚胎数、ET数、妊娠率、着床率、流产率与PCOS胰岛素抵抗的关系。结果三组间基本情况、Gn天数、HCG日内膜厚度、HCG日E2、HCG日P值优质胚胎个数、HCG日内膜厚度、ET个数差异无统计学意义(P>0.05);B组与A组比较妊娠率、着床率、流产率差异无统计学意义(P>0.05),但妊娠率、着床率呈递减趋势,流产率呈增高趋势;A1组与A2组妊娠率、着床率、流产率差异无统计学意义(P>0.05),A1组与B组比较妊娠率,着床率减低,差异有统计学意义(P<0.05),两组流产率差异无统计学意义(P>0.05),但呈增高趋势。结论PCOS人群IVF-ET的临床结局偏差,合并胰岛素抵抗成为降低辅助生殖助孕结局的重要影响因素。     

发生中重度卵巢过度刺激综合征危险因素预测的相关分析

目的本研究通过比较体外受精-胚胎移彬卵母细胞胞浆内单精子注射（IVF—ET／ICSI）助孕患者中发生中重度卵巢过度刺激综合征（OHSS）患者与非OHSS患者相关指标,筛选出其中的危险因素指标,以指导临床工作。方法回顾分析接受IVF—ET／ICSI治疗的不孕患者共1032个周期,发生中重度OHSS38周期为OHSS组,随机选择同期接受IVF—ET／ICSI治疗的患者中未发生OHSS患者38周期作为对照组。结果OHSS组年龄轻,LH／FSH比值高,注射HCG日血E2水平高。启动Gn的用量少,获卵数多,临床妊娠率高。两组比较有显著性差异,（P〈0．05,P〈0．001）．logisitic回归分析结果显示：年龄为保护因素,获卵数,临床妊娠为危险因素。结论年龄,基础LH／FSH比值,注射日血E2水平,获卵数,妊娠对中重度0Hss发生有预测作用。     

卵巢过度刺激综合征发病机制的研究进展

卵巢过度刺激综合症 (ovarianhyperstimulationsyndrome ,OHSS)是在促排卵过程中发生的常见的医源性并发症 ,总发生率约为 2 3% [1] ,表现为双侧卵巢增大、腹胀、恶心呕吐、胸腹水、甚至血栓形成 ,重度患者存在一定的生命危险。随着近二十余年来辅助生殖技术的开展 ,促排卵药物的使用越来越普遍 ,OHSS的发病率也呈上升趋势。临床上在OHSS的诊断、治疗及预防方面已经积累了一定的经验 ,但仍不能作到完全避免OHSS、尤其是重度OHSS的发生 ,治疗方面也缺乏有效的药物 ,而以缓解症状作为主要的治疗目的。因此 ,对于OHSS发病机制的研究…     

硫酸舒喘灵治疗中、重度卵巢过度刺激综合征的临床分析

目的探讨硫酸舒喘灵对中重度卵巢过度刺激综合征（Ovarian hyperstimulation syndrome,OHSS）的治疗作用。方法临床选取40例中重度卵巢过度刺激综合征患者,平均分为治疗组和对照组。治疗组在扩容、补液基础上给予硫酸舒喘灵治疗,对照组仅给予扩容、补液对症治疗,最后对两组疗效进行分析、评估。结果对照组20例中16例妊娠,4例流产,平均住院时间34．3天,平均症状缓解时间3周;治疗组20例中20例妊娠,0例流产,平均住院时间20．8天,平均症状缓解时间1周。两组相比有显著性差异（P〈0．05）。结论硫酸舒喘灵是肾上腺素β2受体兴奋刺,在中重度OHSS治疗中可明显改善患者临床症状及预防流产,缩短住院时间,不失为一种较好的治疗药物。     

Increased early pregnancy loss in IVF patients with severe ovarian hyperstimulation syndrome.

BACKGROUND: Since severe ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of assisted reproduction, the focus of attention in such cases is placed firmly upon the health of the patient, with the endeavour to achieve a pregnancy being considered of secondary importance. The aim of this study was to focus on the pregnancy rate and pregnancy outcome in IVF patients hospitalized for severe or critical OHSS, in one centre, during a period of 6 years. METHODS: We compared the characteristics of patients with severe OHSS: those who conceived with the ones who did not conceive, and among pregnant IVF patients, those with ongoing pregnancies with those that miscarried. RESULTS: Pregnancy was achieved in 60 of 104 (58%) patients with severe OHSS. Pregnancy continued until delivery in 37 of these 60 patients (62%), whereas the remaining 23 (38%) aborted. The pregnancy and abortion rates in patients with severe OHSS were significantly higher than those of IVF patients without OHSS, during the same time period [23% (1138/4922) and 15% (169/1138) respectively, P < 0.001]. The mean duration of hospitalization for OHSS was significantly shorter in those who delivered compared with those who aborted (5.9 +/- 3.2 versus 10.5 +/- 9.6 days, P < 0.01) and in the non-pregnant patients compared with the pregnant patients (5.2 +/- 3.2 versus 7.6 +/- 6.6 days, P < 0.02). CONCLUSIONS: The clinical pregnancy rate of IVF patients with severe OHSS was significantly higher than that of patients without the syndrome. A longer stay in hospital-reflecting a more severe form of OHSS-was correlated with a higher frequency of abortions. OHSS, necessitating hospitalization, is a detrimental clinical situation not only for the mother but also for the developing pregnancy.     

Cortical vein thrombosis misinterpreted as intracranial haemorrhage in severe ovarian hyperstimulation syndrome: case report

A case of cortical vein thrombosis presenting as intracranial haemorrhage is described in a patient with ovarian hyperstimulation syndrome (OHSS) after IVF and embryo transfer. Veno-occlusive disease of the brain could appear as a haemorrhagic lesion on magnetic resonance imaging (MRI) and this made the initial diagnosis of cortical vein thrombosis difficult. The patient developed deep vein thrombosis 2 weeks after the intracranial event and the diagnosis of cortical vein thrombosis was made at that time on MRI study after the resolution of the haemorrhage. This patient actually developed generalized thrombosis as a complication to OHSS. Although the initial MRI picture may be misleading, the diagnosis of thrombosis should always be kept in mind, as it is the commonest cause of intracranial lesions after OHSS.     

Pigtail catheter for the treatment of ascites associated with ovarian hyperstimulation syndrome

BACKGROUND: Severe ovarian hyperstimulation syndrome (OHSS) is potentially dangerous. The study aim was to evaluate the efficacy and safety of percutaneous pigtail catheter drainage for the management of ascites complicating severe OHSS. METHODS: This was a prospective trial conducted at a private IVF centre and a tertiary teaching medical centre. A total of 26 patients with severe OHSS was recruited. Patients were divided into two groups. Patients in group 1 (n = 13) were hospitalized, while patients in group 2 (n = 13) were managed on an outpatient basis. A pigtail catheter was inserted under transabdominal ultrasound guidance and kept in place until drainage ceased. The main outcome measures were resolution of OHSS as determined by symptomatology and laboratory values, time to removal of catheter, patient tolerance of the procedure and complication rate. RESULTS: The catheter was successfully placed in all patients following one attempt and was kept in place for a mean +/- SD of 12.9 +/- 4.3 days (range 7-24). Average amount of fluid drained was 11.2 +/- 4.3 l (range: 3.35-18.5). An improvement of symptoms and signs was noted 24-48 h after catheter placement in all patients in both groups. Procedure was well tolerated and no complications reported. CONCLUSIONS: Percutaneous placement of a pigtail catheter is a safe and effective treatment modality for severe OHSS. It may represent an attractive alternative to multiple vaginal or abdominal paracentesis.     

多囊卵巢综合征不孕患者体外受精与胚胎移植治疗结果分析

目的 分析多囊卵巢综合征(PCOS)不孕患者行体外受精与胚胎移植(IVF-ET)治疗的结果.方法 回顾性分析本中心同期完成IVF-ET的PCOS组74周期和盆腔卵管因素对照组657周期,比较两组治疗周期患者的促性腺激素(Gn)的使用总量和天数、获卵数、正常受精率、卵裂率、移植胚胎数、可利用胚胎率、种植率、基础血清性激素及超排卵中血清性激素水平以及妊娠和分娩结局.结果 基础血清激素中PCOS组促卵泡素(FSH)低于对照组[(5.74±1.74)U/L比(6.63±1.95)U/L];黄体生成素(LH)[(7.68±4.84)U/L比(4.76±2.61)U/L]、LH/FSH(1.38±0.88比0.75±0.42)、总睾酮(T)[(2.07±1.0)nmol/L比(1.54±0.60)nmol/L]高于对照组,差异有统计学意义(P<0.01);基础血催乳素(PRL)、雌二醇(E2)、Gn启动日FSH、LH、E2以及注射绒毛膜促性腺激素日LH、E2、孕酮差异无统计学意义(P>0.05).两组使用Gn的总量与天数、获卵数、正常受精率、卵裂率、平均移植胚胎数及可利用胚胎率差异无统计学意义(P>0.05);PCOS组的妊娠丢失率高于对照组(50%比20%),分娩率(46%比80%)及每周期的活产率(16%比30%)低于对照组,差异有统计学意义(P<0.05);两组生化妊娠率、临床妊娠率、种植率、多胎妊娠率、异位妊娠率及早产率差异无统计学意义(P>0.05).结论 IVF-ET是治疗PCOS不孕症的有效方法,但妊娠丢失率显著增高,应探讨其发生机制及更有效的方法改善妊娠结局.     

Dynamic changes of the immunoglobulins in patients with severe ovarian hyperstimulation syndrome: efficacy of a novel treatment using peritoneo-venous shunt

PROBLEM: To evaluate the efficacy of continuous auto-transfusion system of ascites (CATSA) for the treatment of patients with severe ovarian hyperstimulation syndrome (OHSS) at the risk of febrile morbidity, the dynamic changes of immunoglobulins in the sera and the peritoneal fluid from patients with severe OHSS treated by CATSA were estimated. METHOD OF STUDY: Ten patients with severe OHSS after superovulation for in vitro fertilization-embryo transfer (IVF-ET) were treated by CATSA. Immunoglobulin concentrations were examined in the serum and in the peritoneal fluid before and after CATSA. As controls, serum samples from 15 infertile women, who did not develop OHSS after the same superovulation protocol, were obtained on the day of mid-luteal period (Control-1). Serum samples from 15 patients with OHSS, who were treated by albumin infusion without paracentesis, were also obtained before and after the treatment (Control-2). RESULTS: Before the treatments, serum immunoglobulin G (IgG) concentrations in patients with severe OHSS treated with CATSA and those in patients of Control-2 were significantly lower than those in patients of Control-1 (P < 0.01). Following CATSA, the concentration of IgG increased in the sera, while it decreased in the peritoneal fluid. CONCLUSIONS: Serum IgG in patients with severe OHSS exuded into their peritoneal cavity, indicating that they might be at the status of immunodeficiency and at the risk of febrile morbidity. However, non-infectious febrile morbidity attributed to endogenous pyrogenic mechanism might be considerable. It is also suggested that CATSA might be effective in improving hypoimmunoglobulinemia of the patients with severe OHSS by the peritoneo-venous shunt.     

Incidence of severe ovarian hyperstimulation syndrome after GnRH agonist/HMG superovulation for in-vitro fertilization

In 1673 treatment cycles stimulated with buserelin and HMG, for IVF, GIFT or ZIFT, the severe ovarian hyperstimulation syndrome (OHSS) occurred in 10 cycles (0.6%). Eight patients were hyperandrogenic and showed an increased ovarian response to HMG. After replacement of a maximum of three embryos or zygotes, seven women became pregnant. Three women had a multiple gestation. All patients recovered uneventfully with conservative treatment. Support with progesterone or continuation of the agonist during the luteal phase did not prevent OHSS, confirming that the ovulatory HCG dose is the most important factor in inducing this severe complication. Luteal supplementation with HCG and/or HCG production during implantation could exacerbate OHSS.     

Bilateral partial oophorectomy in the management of severe ovarian hyperstimulation syndrome. An aggressive,but perhaps life-saving procedure

Two case histories are described, in which protracted courses of severe ovarian hyperstimulation syndrome (OHSS) responded poorly to conservative treatment. Each patient underwent bilateral partial oophorectomy at 14 and 16 days respectively, post oocyte retrieval. Serum albumin levels returned to normal within three days of the operation in each case and the patients, one pregnant with twins, made a rapid recovery. This seemingly 'aggressive' procedure is proposed as a potentially useful treatment when faced with patients who are severely or critically affected with OHSS.     

A new approach to the management of patients at risk of ovarian hyperstimulation in an in-vitro fertilization programme.

In this study, we report an alternative method of management of patients at a potential risk of ovarian hyperstimulation syndrome (OHSS) in an in-vitro fertilization (IVF) programme, by the use of gonadotrophin releasing hormone analogue (GnRHa). Thirty eight women considered at risk of this syndrome, having serum oestradiol greater than 4000 pg/ml following ovarian stimulation, received a GnRHa nasal spray for induction of the preovulatory endogenous luteinizing hormone surge for follicular maturation prior to oocyte recovery. Oocyte recovery (mean oocytes per cycle 18.60 +/- 4.79; range 15-35) and IVF were successfully completed in 27 cycles. Twenty six women had embryos replaced and 11 pregnancies occurred (28.9% per operation, 42.3% per replacement cycle). None of the patients developed OHSS. Where there is a risk of OHSS, the use of GnRHa to induce the preovulatory surge of endogenous luteinizing hormone for final follicular maturation provides a successful and more economical alternative to cancellation of cycles.