摘要
在体外受精（invitrofertililization，IVF）周期中，血栓栓塞是卵巢过度刺激综合征（ovarianhyperstimulationsyndrome，OHSS）中最严重的并发症，而促性腺激素是诱发血栓栓塞的最主要原因。易栓症标志分子的作用存在争议。在IVF周期中，血栓的发病率为0．11％，致死率为1／45000--1／500000。血栓通常发生在静脉（67％-81％），多为头颈部，动脉血栓（19％～33％）多发于脑部。精确识别OHSS高危患者，对其选择恰当的促排卵方案和促性腺激素剂量，并结合冷冻全部卵子或胚胎后行冻融胚胎移植，将显著降低高危患者血栓栓塞的风险。一旦血栓栓塞被早期确诊，使用抗凝剂肝素进行预防就显得尤为关键。但是，减少卵巢刺激后血栓形成风险的最有效方法是识别OHSS高危患者并及时采取预防措施。本文分析促排卵过程中发生OHSS患者血栓形成的发病机理及临床表现，并为此提出实用的预防和治疗方案。
Among in vitro fertilization （IVF） cycle, thrombosis is the most serious complication of ovarian hyperstimulation syndrome （OHSS）, and gonadotrophin is the most important reason of thrombosis induction. The influence of thrombophilia on OHSS and thrombotic complications of ovarian stimulation is very controversial. The incidence of thromboembolism in women undergoing IVF cycle was 0.11%, and the mortality rate was 1/45 000- 1/500 000. Thrombosis generally occurred in vein （67%-81%）, mostly in neck and head, arterial thrombosis （19%- 33%） mostly occurred in head. The risk of thrombosis can be reduced significantly for patients through exactly identifying these high-risk women with OHSS, and then to select one proper ovulation-inducing programme and gonadotrophin dosage following a freeze-all strategy with subsequent replacement of embryos or oocytes in the context of a frozen-thawed embryo transfer （FET）. Once early diagnosis is established, it is crucial to use an anticoagulant treatment with heparin proceeded with thromboprophylaxis. However, identification of high-risk patients with OHSS and adoption of preventive measures are the best means in reducing the risk of thrombosis after ovarian stimulation. The aim of this review is to analyse the pathophysiology and complications of thrombosis in conjuction with OHSS following ovulation induction and to suggest practical guidelines for the prevention and treatment.
出处
《生殖与避孕》
CAS
CSCD
北大核心
2015年第9期644-649,共6页
Reproduction and Contraception
基金
兰州军区医药卫生科研项目
项目号为CLZ14JB08
