体外受精-胚胎移植术后宫内外同时妊娠的影响因素分析  

Influencing factors of simultaneous intrauterine pregnancy after invitro fertilization and embryo transfer

作　　者：杨小杰[1] 陈昀 何桦 黄俊敏 Yang Xiaojie;Chen Yun;He Hua;Huang Junmin(Tangshan Maternal and Child Health Hospital,Tangshan 063210,China)

机构地区：[1]河北省唐山市妇幼保健院,063000 [2]玉田县中医院

出　　处：《现代养生》2021年第6期20-24,共5页Health Protection and Promotion

基　　金：2018年度河北省医学科学研究重点课题(编号:20181336)。

摘　　要：目的探讨体外受精—胚胎移植(IVF-ET)后宫内外同时妊娠(HP)的发病危险因素,为尽早确诊及治疗HP,为提高宫内持续妊娠率提供理论依据。方法收集2010年1月—2020年12月于医院行体外受精—胚胎移植(IVF-ET)助孕患者的临床资料,追踪其妊娠结局。依据妊娠结局,选取助孕后发生HP患者45例为病例组,选取同期行IVF-ET治疗后正常宫内妊娠者98例为对照组。采用单因素分析比较两组患者的一般情况(年龄、体质量指数、不孕年限、宫腔操作史、异位妊娠(EP)史、输卵管手术史、盆腔炎性疾病史、不孕类型、子宫输卵管造影结果、不孕原因)、治疗周期中相关参数指标,如肌注HCG日子宫内膜厚度、肌注HCG日E2水平、肌注HCG日Gn水平、卵巢过度刺激综合征(OHSS)、移植第12天HCG水平,探讨其中有统计学意义的相关影响因素,并进行多因素分析。结果单因素分析显示,病例组异位妊娠史、宫腔操作史、输卵管手术史、不孕原因及OHSS的比例高于对照组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,异位妊娠史(OR=10.793,95%CI:3.105-37.513)、宫腔操作史(OR=1.355,95%CI:1.205-3.973)及OHSS(OR=4.42),95%CI:1.930-10.167),是HP发生的独立影响因素。结论行IVE-ET助孕患者,术前合并异位妊娠史、宫腔操作史或助孕过程中发生OHSS,增加IVF-ET术后HP发生风险,建议术后加强监测,尽早确诊及时治疗,避免腹腔大出血等严重并发症,提高宫内持续妊娠率。Objective To explore the risk factors of intrauterine pregnancy(HP)after in vitro fertilization and embryo transfer,HP,for early diagnosis and treatment.To improve the rate of intrauterine continuous pregnancy and to provide theoretical basis.Methods To collect the clinical data of in vitro fertilization-embryo transfer(IVFET)in our hospital from January 2010 to December 2020,Follow up the pregnancy outcome.Based on pregnancy outcomes,A case group of 45 patients with HP after pregnancy,98 cases of normal intrauterine pregnancy after IVF-ET treatment were selected as control group.Using single factors to compare the general conditions of the two groups(age,body mass index,infertility years,uterine cavity operation history,EP history,fallopian tube surgery history,pelvic inflammatory disease history,type of infertility,hysterosalpingography results,reasons for infertility),relevant parameters in the treatment cycle(HCG days of intramuscular injection,HCG days,intramuscular injection day E2 level,intramuscular injection day Gn level,OHSS,transplantation day 12 HCG level),to explore the statistically significant factors,and conduct multifactorial analysis.Results Univariate analysis showed that the incidence of ectopic pregnancy history,uterine cavity operation history,fallopian tube surgery history,infertility reasons and OHSS in the case group were higher than those in the control group(P<0.05),and the difference was statistically significant.Multivariate regression logistic regression analysis showed that the history of ectopic pregnancy(OR=10.793,95%CI:3.105-37.513),history of uterine cavity operation(OR=1.355,95%CI:1.205-3.973)and OHSS(OR=4.42,95%CI:1.930-10.167),all the above factors are independent factors of HP occurrence.Conclusion IVE-ET the Pregnant patients,preoperative history of ectopic pregnancy,uterine cavity operation,OHSS,during pregnancy to increase the risk of IVF-ET postoperative HP.It is recommended to strengthen monitoring after surgery,early diagnosis and treatment,avoid severe complications s

关 键 词：人工授精—胚胎移植术 宫内外同时妊娠 危险因素 分析 

分 类 号：C714.2[社会学]