本文選題：受精 + 體外�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2014年碩士論文

【摘要】：背景和目的 卵巢過度刺激綜合征(ovarian hyperstimulation syndrome, OHSS)是輔助生殖技術(shù)中藥物刺激卵巢方案常見的醫(yī)源性并發(fā)癥。其潛在病因和發(fā)病機(jī)制尚不清楚,但卵巢來源的血管活性因子參與了血管通透性的增加和新生血管的生成,表現(xiàn)為卵巢囊性增大,液體從血管內(nèi)迅速轉(zhuǎn)移至第三間隙,血容量急劇降低,引發(fā)急性血流動力學(xué)改變,繼而引起腹水、胸水、心包積液甚至全身水腫,出現(xiàn)腹脹腹痛、血液濃縮、低血容量、少尿、肝腎功能障礙,嚴(yán)重者可引起血栓形成、急性呼吸窘迫綜合癥(ARDS)、腎功能衰竭甚至危及生命。上述病理生理過程以及針對OHSS所采取的對癥處理措施是否會對IVF患者的妊娠結(jié)局造成不良影響尚不可知,本研究的目的：比較OHSS與無OHSS的IVF患者的妊娠結(jié)局,探討并發(fā)OHSS對IVF患者妊娠結(jié)局有無不良影響。 資料和方法 收集2002年1月～2012年12月在北京協(xié)和醫(yī)院生殖中心接受體外受精-胚胎移植(IVF-ET)(包括ICSI)的5487例患者的周期資料,選擇其中發(fā)生中重度OHSS住院治療的190例患者作為研究組,按照年齡及所獲成熟卵子數(shù)目配對選擇同期未發(fā)生OHSS的197例患者作為對照組。對兩組患者的臨床資料進(jìn)行回顧性分析,比較兩組患者IVF-ET治療后的妊娠結(jié)局。 結(jié)果 OHSS患者臨床妊娠率為91.8%(168/183),無OHSS患者臨床妊娠率為45.1%(80/184),差異有統(tǒng)計學(xué)意義(P0.001)；兩組的活產(chǎn)率分別為82.7%(139/168)和78.8%(63/80),流產(chǎn)率分別為16.1%(27/168)和17.5%(14/80),胎兒丟失率分別為1().1%(17/168)和10).0%(8/80),早產(chǎn)率分別為20.9%(29/139)和17.5%(11/63),差異均無顯著性(P0.05)；兩組≤3,4周分娩率分別為8.6%(12/139)和7.9%(5/63)、胎兒宮內(nèi)窘迫發(fā)生率分別為2.9%(4/139)和3.2%(2/63)、剖宮產(chǎn)率分別為84.9%(118/139)和66.3%(53/63),差異均無顯著性(P0.05)；兩組平均分娩孕周分別為37.7±2.3周和37.7±2.0周、新生兒平均出生體重分別為2813±620g和2880±607g、足月低體重出生兒比率分別為13.0%(25/139)和10.6%(9/63)、早產(chǎn)低體重出生兒比率分別為6.3%(12/139)和3.5%(3/63),差異均無顯著性(P0.05) 結(jié)論 OHSS患者臨床妊娠率顯著高于無OHSS患者,而流產(chǎn)率、胎兒丟失率、早產(chǎn)率、低體重出生兒等不良圍生兒并發(fā)癥與無OHSS患者相比未見升高。
[Abstract]:Background and purposeOvarian hyperstimulation syndrome (OHSS) is a common iatrogenic complication of ovarian hyperstimulation therapy in assisted reproductive technology.The underlying etiology and pathogenesis are unknown, but vasoactive factors derived from the ovary are involved in increased vascular permeability and angiogenesis, which are characterized by cystic enlargement of the ovary and rapid transfer of fluid from the intravascular to the third space.A sharp decrease in blood volume leads to acute hemodynamic changes, which in turn cause ascites, pleural effusion, pericardial effusion and even systemic edema, abdominal distention and abdominal pain, blood concentration, hypovolemia, oliguria, liver and kidney dysfunction,Severe cases can cause thrombosis, acute respiratory distress syndrome (ARDS), renal failure and even life-threatening.It is not known whether the pathophysiological process mentioned above and the measures taken to deal with OHSS will have adverse effects on the pregnancy outcome of IVF patients. The purpose of this study was to compare the pregnancy outcomes of OHSS patients with IVF patients without OHSS.To investigate the adverse effects of OHSS on pregnancy outcome in IVF patients.Information and methodologyFrom January 2002 to December 2012, 5487 patients who received IVF-ETX (including OHSS) at the Reproductive Center of Peking Union Hospital were collected as the study group, and 190 patients with moderate and severe OHSS were selected as the study group.According to age and the number of mature eggs, 197 patients without OHSS were selected as control group.The clinical data of the two groups were analyzed retrospectively and the pregnancy outcomes after IVF-ET treatment were compared between the two groups.ResultThe clinical pregnancy rate in patients with OHSS was 91.88 / 183 and that in patients without OHSS was 45.1a / 80 / 1844, the difference was statistically significant (P 0.001); the live births in the two groups were 82.7 / 139- / 139168) and 78.8 / 63.80 / 80, respectively, and the abortion rates were 16.1- 2727168) and 17.5/ 14- / 80m, respectively, and the fetal loss rates were 1 / 17168) and 10.0 / 880, respectively, and the premature rate was 20.90.29r.r.139.The average birth weight of newborns was 2813 鹵620g and 2880 鹵607g, respectively. The ratio of full-term low birth weight infants was 13.010 / 139and 10.6 / 9 / 63g, respectively. The ratio of preterm low birth weight newborns was 6.3p / 139and 3.5b / 3.63g, respectively. There was no significant difference (P0.05).ConclusionThe clinical pregnancy rate in patients with OHSS was significantly higher than that in patients without OHSS, while the rate of abortion, fetal loss, premature delivery, low birth weight and other adverse perinatal complications did not increase compared with those without OHSS.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.8

【參考文獻(xiàn)】

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1 刁飛揚(yáng);王嫜;黃潔;吳畏;吳春香;侯振;劉金勇;孟艷;冒韻東;舒黎;馬翔;劉嘉茵;;拮抗劑方案中應(yīng)用促性腺激素釋放激素激動劑誘發(fā)卵母細(xì)胞成熟后不同黃體支持方案對妊娠結(jié)局的影響——一項(xiàng)提前終止的前瞻隨機(jī)臨床對照研究[J];生殖醫(yī)學(xué)雜志;2013年10期

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