本文選題：卵巢過度刺激綜合征　切入點：羥乙基淀粉　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究目的:探討卵巢過度刺激綜合征(Ovarian Hyperstimulation Hyndrome,OHSS)的高危因素;分析妊娠、OHSS發(fā)生時間與中、重度OHSS相關性;以白蛋白為對照組,研究萬汶對于中、重度OHSS的治療效果,為OHSS臨床觀察、治療提供依據。方法:選取2013年8月至2014年12月在吉林大學白求恩第一醫(yī)院生殖婦科住院接受體外受精-胚胎移植(In Vitro Fertilizationembryotransfer,IVF-ET)的中、重度OHSS患者70例,采取Logistic回歸分析法分析中、重度OHSS的高危因素。根據2009年Golan【1】等提出的診斷標準分為中度OHSS 34例和重度OHSS 36例;根據是否合并妊娠分為妊娠組11例和未妊娠組59例;根據發(fā)病時間分為早發(fā)型OHSS組54例和遲發(fā)型OHSS組16例。研究妊娠、OHSS發(fā)病時間與中、重度OHSS的相關性。根據治療方式不同分為研究組35例和對照組35例。研究組給予靜脈滴注萬汶1 000毫升,1/日,連續(xù)5天;對照組給予靜脈滴注白蛋白12.5克,1/日,連續(xù)5天。觀察2組治療前、治療后5天血常規(guī)及肝功能的變化和治療臨床效果的比較,并進行統(tǒng)計學分析。結果:1一般資料:70例OHSS患者在年齡、體質量指數(Body Mass Index,BMI)、注射人絨毛促性腺激素(Human Chorionic Gonadotropin,HCG)日雌二醇(E2)值和穿刺卵泡數之間比較無統(tǒng)計學差異(p0.05)。Logistic回歸分析結果顯示:年齡和體質量指數為OHSS發(fā)生的保護因素(OR1);而注射HCG日E2值和取卵穿刺卵泡數為OHSS發(fā)生的危險因素(OR1)。2妊娠與中、重度OHSS的相關性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%)。兩者比較有統(tǒng)計學意義(p=0.004、p0.05)。3 OHSS發(fā)病時間與中、重度OHSS的相關性70例OHSS患者中早發(fā)型OHSS 54例,其中中度OHSS者33例(61%),重度OHSS者21例(39%);遲發(fā)型OHSS 16例,其中中度OHSS者1例(6%),重度OHSS者15例(94%)。兩者比較有統(tǒng)計學差異(p=0.0001、p0.05)。4治療措施70例中重度OHSS患者均給予白蛋白或萬汶擴容等對癥治療,其中35例OHSS患者應用萬汶1000毫升1次/日,連用5日;另外35例OHSS患者應用白蛋白12.5克1次/日,連用5日。34例中度OHSS患者中行腹腔穿刺術治療的共1例(3%);36例重度OHSS患者中行腹腔穿刺術治療的共15例(42%),其中1例(3%)重度OHSS合并胸水行胸腔穿刺術治療。放腹水量最多的是4000毫升。5研究組與對照組之間比較5.1血常規(guī)指標:組間比較:治療前2組白細胞計數和Hct值分別比較差異無統(tǒng)計學意義(p0.05);治療后5天,萬汶組白細胞計數、Hct值顯著低于白蛋白組,但差異無統(tǒng)計學意義(p0.05)。組內比較:2組治療后5天的白細胞計數、血Hct值均低于治療前,差異有統(tǒng)計學意義(p0.05)。5.2肝功能指標:組間比較:治療前2組谷丙轉氨酶和谷草轉氨酶指標分別比較差異無統(tǒng)計學意義(p0.05);治療后5天2組谷丙轉氨酶和谷草轉氨酶指標分別比較差異無統(tǒng)計學意義(p0.05)。組內比較:2組治療后5天谷丙轉氨酶和谷草轉氨酶指標較治療前均無明顯變化,差異無統(tǒng)計學差異(p0.05)。5.3臨床療效:治療后5天,研究組治療有效率是85.7%;對照組治療有效率是80%,但2組比較無統(tǒng)計學意義(p0.05)。結論:1患者年齡過小、低BMI、注射HCG日E2值過高和取卵穿刺卵泡數過多是OHSS發(fā)生的高危因素。2妊娠可以加重OHSS嚴重程度。3遲發(fā)型OHSS患者臨床癥狀較早發(fā)型OHSS患者癥狀嚴重。4在中、重度OHSS患者治療上萬汶和白蛋白都有擴容的作用,且作用效果相似。與白蛋白相比,萬汶副反應發(fā)生率低、輕微、價格便宜且使用安全,是成為OHSS擴容治療首選。
[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，

本文編號：1566490