探讨不同阴道冲洗方法对IVF-ET患者阴道微生态和妊娠结局的影响  

Influence of two vaginal irrigation methods on vaginal microflora and pregnancy outcomes of IVF-ET patients

作　　者：陈伟微 CHEN Weiwei(Department of Reproductive Medicine Centre,Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]北京首都医科大学附属北京朝阳医院生殖医学中心,北京100020

出　　处：《空军航空医学》2023年第1期49-52,共4页AVIATION MEDICINE OF AIR FORCE

摘　　要：目的比较2种不同阴道冲洗方法对体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕患者阴道微生态和妊娠结局影响,探索取卵术前阴道准备最佳方式。方法收集2019年1月-2021年12月在首都医科大学附属北京朝阳医院生殖医学中心接受IVF-ET助孕治疗患者370例共2188周期,筛选卵巢功能正常且新鲜移植370个周期,分为对照组(n=178)和试验组(n=192)。对照组在人绒毛膜促性腺激素(human chorionic gonadotropino,HCG)扳机日和取卵术前分别对患者行0.9%生理盐水阴道冲洗;试验组在HCG扳机日和取卵术前分别行0.9%生理盐水+0.4%庆大霉素阴道冲洗。2组分别于取卵术前用无菌采样棉拭子于阴道后穹窿取样,并于取卵后72 h行新鲜胚胎移植。结果试验组和对照组的临床妊娠率分别为51.63%和53.55%,生化妊娠率分别为63.04%和65.20%,差异均无统计学意义(P>0.05);试验组阴道菌群密集度Ⅰ、Ⅱ度占比分别为66.67%、33.33%,对照组分别为74.72%、25.28%,差异无统计学意义(P>0.05);试验组阴道卷曲乳杆菌、加氏乳杆菌、姜氏乳杆菌、惰性乳杆菌占比分别为(15.09±4.16)%、(11.09±3.64)%、(10.24±3.57)%、(15.09±3.21)%,对照组分别为(13.17±4.04)%、(11.87±3.57)%、(11.49±3.44)%、(16.38±3.64)%,差异均无统计学意义(P>0.05)。结论0.9%生理盐水联合0.4%庆大霉素用于取卵术前阴道冲洗,在维持阴道内稳态的同时不影响胚胎着床,可作为取卵术前的常用阴道准备方法。Objective To compare the effects of two different vaginal irrigation methods on vaginal microecology and pregnancy outcomes in patients undergoing IVF-ET assisted pregnancy,and to discover the best way of vaginal preparation before oocyte retrieval.Methods The data on 2188 cycles of IVF-ET assisted pregnancy treatment in our center between 2019 and 2021 was collected.Three hundred and seventy cycles of fresh ovarian transplantation with normal ovarian function were screened and divided into the control group(n=178)and the test group(n=192).Vaginal lavage was performed on the day of HCG and the day before oocyte retrieval in both groups.Those in the control group were administered with 0.9%saline while the test group was given 0.9%saline combined with 0.4%gentamicin.After different treatment,patients were sampled in the posterior vaginal fornix with sterile cotton swabs before oocyte retrieval,and fresh embryo transfer was performed 72 hours after oocyte retrieval.Results The clinical pregnancy rates in the test group and the control group were 51.63%and 53.55%,respectively,while the biochemical pregnancy rates were 63.04%and 65.20%,respectively,so there was no significant difference(P>0.05)between the two groups.The percentage of vaginal flora density Ⅰ and Ⅱ in the test group was 66.67%and 33.33%respectively,compared with 74.72%and 25.28%respectively in the control group,so there was no significant difference(P>0.05)between the two groups.The proportions of Lactobacillus flexus,Lactobacillus canadensis,Lactobacillus johnsonii and Lactobacillus inertii in patients in the test group were(15.09±4.16)%,(11.09±3.64)%,(10.24±3.57)%and(15.09±3.21)%,respectively,compared with(13.17±4.04)%,(11.87±3.57)%,(11.49±3.44)%and(16.38±3.64)%respectively in the control group,so there was no significant difference(P>0.05)between the two groups.Conclusion 0.9%normal saline combined with 0.4%gentamicin can be used for vaginal flushing before ovum retrieval,which can maintain the stability of vagina without affecting embry

关 键 词：体外受精-胚胎移植 阴道冲洗 庆大霉素 妊娠结局 阴道菌群 

分 类 号：R246.3[医药卫生—针灸推拿学]