序贯药物组合方案在防治中/重度卵巢过度刺激r综合征中的作用

摘要

目的 探讨二甲双胍、醋酸泼尼松片、阿司匹林、溴隐亭、来曲唑在预防及治疗体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)产生的卵巢过度刺激综合征(OHSS)中的作用.方法 回顾性分析2013年4月-2016年3月在宁夏医科大学总医院生殖医学中心接受IVF/ICSI-ET长方案促排卵中有发生OHSS倾向的不孕症患者772个周期,其中485个周期行鲜胚移植,287个周期行全胚冻存;移植周期中有280例在采卵日给予二甲双胍及醋酸泼尼松片联合万汶/万衡等预防OHSS发生,作为移植观察组,205例仅给予万汶/万衡等预防OHSS发生,作为移植对照组;全胚冻存组中175例在采卵日给予二甲双胍、醋酸泼尼松片、阿司匹林、溴隐亭、来曲唑联合万汶/万衡等预防OHSS发生,作为冷冻观察组,112例仅给予万汶/万衡等预防OHSS发生,作为冷冻对照组,分别分析观察组和对照组的临床疗效.结果 移植观察组中/重度OHSS的发生率低于移植对照组(5.36%vs 12.68%,P<0.01);移植观察组早期流产率低于移植对照组(7.91%vs 14.00%,P<0.01),两组在生化妊娠率和临床妊娠率方面差异无统计学意义(P>0.05);冷冻观察组中/重度OHSS发生率低于冷冻对照组(1.71%vs 4.46%,P<0.01).结论 二甲双胍、醋酸泼尼松片、阿司匹林、溴隐亭、来曲唑在预防及治疗OHSS发生中具有较为明确的疗效,应用二甲双胍及醋酸泼尼松片亦可降低早期流产率,且不影响临床妊娠率.%Objective To explore the effects of admistering metformin, prednisone acetate tablets, aspirin,bromocriptine, and letrozole on the prevention and treatment of ovarian hyperstimulation syndrome (OHSS)resulted from in vitro fertilization and embryo transplantation or intracytoplasmic sperm injection andembryo transplantation(IVF/ICSI-ET). Methods The data from April 2013 to March 2016 in Reproductive Medicine Center,General Hospital of Ningxia Medical University were analyzed retrospectively and the studyincluded 772 cycles of infertility patients who received IVF/ICSI-ET long protocol to stimulate ovulation andresulted in OHSS tendency during the treatment. There were 485 fresh embryo transplants and 287 frozen embryotransplants. In the fresh transplant cycle,280 cases were given metformin and prednisone acetate tabletscombined with voluven/Wan Heng etc., on OPU day to prevent OHSS as transplant observation group, while 205cases were only given voluven/Wan Heng etc., to prevent OHSS as transplant control group. In the frozen embryogroup 175 cases were given metformin, prednisone acetate tablets, aspirin, bromocriptine and letrozoleconbined with voluven/Wan Heng etc. on the OPU day to prevent OHSS as frozen observation group, while 112cases were only given voluven/Wan Heng etc.to prevent OHSS as frozen control group.The clinical effects ofobservation groups and control groups were analyzed respectively. Results In the transplant observation group,the morbidity rate of severe OHSS was significantly lower than that in the transplant control group(5.36% vs12.68%, P<0.01). The rate of early abortion in transplant observation group was significantly lower than thatin the transplant control group(7.91%vs 14.00%,P<0.01). There was no significant difference between twogroups in terms of biochemical pregnant rate and clinical pregnant rate(P>0.05). In the frozen observationgroup, the morbidity rate of severe OHSS was significantly lower than that in the frozen control group(1.71%vs 4.46%). Conclusion Metformin, prednisone acetate tablets, aspirin, bromocriptine and letrozoleare relatively effective in the prevention and treatment of OHSS,while admistering metformin and prednisoneacetate tablets can decrease the rate of early abortion, but they will not affect the clinical pregnancy rate.