多次经阴道穿刺抽吸腹水对重度卵巢过度刺激综合征患者治疗结局的影响  

Effect of multiple transvaginal puncture-aspiration of ascites on the therapeutic outcome of severe ovarian hyperstimulation syndrome patients

作　　者：柯雪 邝莉 王芳 Ke Xue;Kuang Li;Wang Fang(Department of Reproductive Medicine,Chengdu Women's and Children's Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China)

机构地区：[1]电子科技大学医学院附属妇女儿童医院,成都市妇女儿童中心医院生殖中心,成都611731

出　　处：《中华生殖与避孕杂志》2022年第3期277-282,共6页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨多次经阴道穿刺抽吸腹水在重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)合并张力性腹水处理中的临床效果。方法选取成都市妇女儿童中心医院生殖中心2010年6月至2020年7月期间行助孕取卵术后发生重度OHSS并经阴道穿刺抽吸腹水的186例患者进行回顾性队列研究,按腹水抽吸次数不同分为单次抽吸组(n=116)和多次抽吸组(n=70)。两组患者均进行了补液、扩容及抗凝治疗。比较两组患者补液总量、白蛋白及低分子肝素用药量、住院时间及并发症发生情况,并通过多元logistic回归分析患者的满意度。结果多次抽吸组腹水抽液总量[(6.89±1.24)L]明显高于单次抽吸组[(3.09±0.65)L],差异有统计学意义(P<0.001);单次抽吸组补液总量[(12965.52±3796.29)mL]、白蛋白输入量[(131.77±45.38)g]及低分子肝素注射总量[(53017.24±12629.84)U]与多次抽吸组[(9485.71±3470.34)mL、(94.57±47.91)g、(38071.43±12490.37)U]对比,差异均有统计学意义(均P<0.001);多次抽吸组住院时间[(8.01±2.66)d]明显短于单次抽吸组[(10.81±2.65)d],差异有统计学意义(P<0.001);多次抽吸组术后并发症发生率与单次抽吸组比较,差异无统计学意义(P>0.05)。多元logistic回归结果显示,抽吸次数不是影响患者满意度的重要因素[OR=0.593(95%CI=0.134~2.623),P=0.491],白蛋白用量和住院时间是影响患者满意度的重要因素[OR=0.868(95%CI=0.757~0.996),P=0.043;OR=0.389(95%CI=0.154~0.979),P=0.045]。结论经阴道多次穿刺抽吸腹水对于合并反复张力性腹水的重度OHSS患者能迅速缓解症状,缩短治疗时间,减少用药量,是一种安全有效的治疗方法。Objective To explore the clinical effect of multiple transvaginal puncture-aspiration for ascites drainage on the management of severe ovarian hyperstimulation syndrome(OHSS)combined with tense ascites.Methods From June 2010 to July 2020,186 cases who developed severe OHSS after oocyte collection and received ascites puncture at Department of Reproductive Medicine of Chengdu Women's and Children's Central Hospital were collected and divided into single aspiration group(n=116)and multiple aspiration group(n=70)according to the different ascites aspiration times.Patients in both groups were given fluid infusion,expansion and anticoagulant therapy.Then,the therapeutic outcomes between the two groups were compared.Results The ascites volume in multiple aspiration group[(6.89±1.24)L]was apparently higher than that in single aspiration group[(3.09±0.65)L],the difference was of statistical significance(P<0.001).The differences of the total fluid infusion volume[(12965.52±3796.29)mL vs.(9485.71±3470.34)mL],the albumin infusion volume[(131.77±45.38)g vs.(94.57±47.91)g],the total low-molecular-weight heparin(LMWH)volume[(53017.24±12629.84)U vs.(38071.43±12490.37)U]between single aspiration group and multiple aspiration group were statistically significant(all P<0.001).Moreover,the length of hospital stay in multiple aspiration group was(8.01±2.66)d,which was markedly shorter than that in single aspiration group[(10.81±2.65)d],and the difference was statistically significant(P<0.001).The difference of the postoperative complication rate between multiple aspiration group and single aspiration group was not statistically significant(P>0.05).Multivariate logistics results showed that the number of aspiration was not an important factor affecting patients'satisfaction[OR=0.593(95%CI=0.134-2.623),P=0.491],while the amount of albumin and length of hospital stay were important factors affecting patients'satisfaction[OR=0.868(95%CI=0.757-0.996),P=0.043;OR=0.389(95%CI=0.154-0.979),P=0.045].Conclusion Multiple transvaginal

关 键 词：卵巢过度刺激综合征 重度 腹水 经阴道抽吸 

分 类 号：R711.75[医药卫生—妇产科学]