摘要: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(IVFET)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。Abstract: Objective: To present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS) in clinical material. Methods: The clinical materials of 77 cases with OHSS treated in our hospital were analyzed retrospectively. Results: Patients were treated with rehydration with intravenous crystalloids and colloids and ultrasoundguided paracentesis if symptoms of ascites become severe. Monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done.77 cases were cured.Conclusion:The management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications. Rehydration is the key of medical treatment. Termination of pregnancy is a most effective management.
ObjectiveTo systematically review the efficacy and safety of intravenous calcium infusion for preventing ovarian hyperstimulation syndrome (OHSS). MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 7, 2015), CNKI, Sinomed and WanFang Data were searched from inception to July 2015 to collect randomized controlled trials (RCTs) and non-RCTs about intravenous calcium infusion for OHSS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of six studies involving 1 061 women were included. The results of meta-analysis showed that intravenous calcium infusion could reduce the incidence of moderate OHSS (RR=0.27, 95% CI 0.11 to 0.65, P=0.003), but not the incidence of severe OHSS (RR=0.77, 95% CI 0.23 to 2.63, P=0.68). In addition, intravenous calcium infusion had a tendency to increase the pregnant rate (RR=1.19, 95% CI 0.94 to 1.50, P=0.15). The subgroup analysis showed that, compared with placebo/no treatment, intravenous calcium infusion reduced the incidence of moderate OHSS, but not the incidence of severe OHSS. There were no statistical differences between intravenous calcium infusion and other positive control (cabergoline and hydroxyethyl starch) in the incidence of OHSS and pregnant rate. No side effect was reported in the studies included. ConclusionsCurrent evidence indicates that intravenous calcium infusion can reduce the incidence of OHSS without influence pregnant outcomes. Due to the quantity and quality limitations of included studies, more high quality case-control or cohort studies are needed to verify the above conclusions.
Objective To retrospectively analyze the emergency complications of the patients after oocyte retrieval with assisted reproductive technology (ART), and analyze the corresponding strategies. Methods The clinical data of patients after oocyte retrieval with ART between January and December 2016 were retrospectively anayzed. The postoperative emergency complications were observed. Results A total of 5 013 patients were included in the study. The common emergency complications after oocyte retrieval included vaginal bleeding in 137 cases (2.73%) , ovarian hyperstimulation syndrome (OHSS) in 35 (0.69%), hematuria caused by bladder injury in 11 cases (0.21%), pelvic infection in 3 (0.06%), and vagal reflex in 2 (0.04%). OHSS was related to age, the number of basal follicles, the number of oviposaccharides and the estradiol level on the day of human chorionic gonadotropin injection, but not related to the body mass index and the number of days of gonadotropin use; which might be misdiagnosed most likely. Conclusions OHSS is one of the common and severe emergency complications after oocyte retrieval with ART, which should be concerned. Active treatment of complications is helpful to reduce the incidence of emergency complications after oocyte retrieval with ART.