血栓——辅助生殖助孕中最严重的并发症  

Thrombosis—The most dangerous complication in assisted reproduction technology

作　　者：孙雯 王彬[1] SUN Wen;WANG Bin(Lanzhou General Hospital of the Chinese People＇s Liberation Army,Lanzhou 73000)

机构地区：[1]中国人民解放军兰州总医院,兰州730000

出　　处：《中国优生与遗传杂志》2018年第10期3-6,9,共5页Chinese Journal of Birth Health & Heredity

摘　　要：本文目的是分析试管婴儿(in vitro fertililization,IVF)助孕过程中促排卵引发的卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)及其血栓并发症形成的病理生理学特点,并对此提出实用性的治疗方案。尽管在IVF周期中血栓发生率为0.2%左右,但在重度OHSS患者中可达到10%,这说明血栓是OHSS中最严重的并发症。可通过窦卵泡数(AFC)和抗苗勒氏管激素(AMH)来识别具有潜在OHSS风险的患者。对于AFC和AMH高水平患者采用GnRH拮抗剂和传统的hCG进行扳机,将减少OHSS风险并仍可进行新鲜周期移植。通过将IVF周期分割开来,使用GnRH激动剂替代hCG促进卵子的最后成熟,然后冷冻全部卵子或胚胎,在冷冻胚胎移植周期进行选择性的单胚胎移植,并与经典的血栓预防方案相结合,可显著降低血栓栓塞的发生。一旦血栓栓塞被早期确诊,采用适宜的治疗措施就显得尤为关键。但是,识别OHSS高风险患者并对其采取预防措施是减少卵巢刺激后血栓形成风险的最有效方法。The aim of this review is to analyze the pathophysiology and complications of thrombosis in conjunction with ovarian hyperstimulation syndrome（OHSS）following ovulation induction and to suggest practical guidelines useful for the prevention and treatment. Although the incidence of thrombosis varies from 0.2% among in vitro fertilization（IVF）cycles and up to 10% for severe cases of the syndrome,it represents the most dangerous complication of OHSS. The women with dangerous complication of OHSS could be distinguished by antral follicle count（AFC）and anti-Mullerian hormone（AMH）. For those women with a high AFC or AMH combining a GnRH antagonist with a conventional hCG trigger will reduce the risk of OHSS and still allow a fresh transfer to occur. The incidence of thrombosis could be dramatically reduced by segmentation of the IVF cycle using a GnRH agonist for final oocyte maturation and then freezing all oocytes or embryos with subsequent replacement of a single embryo in the context of a frozen embryo transfer,and combining to the conventional prevention project for thrombosis. However,identification of patients at risk and preventive measures of OHSS are the best means in reducing the risk of thrombosis after ovarian stimulation.

关 键 词：血栓 卵巢过度刺激综合征 辅助生殖技术 

分 类 号：R321-33[医药卫生—人体解剖和组织胚胎学]