课件：卵巢过度刺激综合征.ppt

卵巢过度刺激综合征（ ovarian hyperstimulation syndrome, OHSS） 孔 令 红 卵巢过度刺激综合症是指在应用药物促排卵之后出现的一些症状，对卵巢刺激过度产生的并发症； 促排卵产生许多卵泡，分泌大量雌二醇以及HCG的应用引起胸腹水，尿少，血液浓缩，电解子紊乱，肝肾功能受损的变化。 The incidence of significant Ovarian Hyperstimulation Syndrome in the IVF program is 1 to 5% of all patients. The majority of patients with even quite severe levels of Ovarian Hyperstimulation Syndrome get better within 7 to 10 days. 发病机理 OHSS的主要病理特征是全身毛细血管增生和通透性增加，这种现象尤见于卵巢组织；从而，导致体液渗出，血液浓缩，水电解质平衡失调。 这种血管病理改变的机制可能与多种炎性介质和炎性细胞因子有关。 （1）前列腺素： HCG可活化花生四烯酸转换成前列腺素所需的环氧酶，且病人体内较高的雌激素水平，二者共同促进前列腺素的分泌，前列腺素使组织胺产生增加，从而增加毛细血管的通透性。一方面漏出液潴留在卵泡腔内形成囊状卵泡；另一方面使血液外移，从而产生胸腹水甚至全身水肿等症状。 （2）R-A-A系统： 卵巢存在R-A-A系统。OHSS病人血浆肾素活性增高与其严重程度呈正相关。外源性（促排卵药）或内源性（妊娠）HCG均可使血液及卵泡液中的肾素增加，从而使其间肾素的转化增加，激活R-A-A系统。该系统主要是通过最终活性产物血管紧张素Ⅱ，影响血管生成及毛细血管的通透性而起作用。 Symptoms and signs of OHSS Lower abdominal pain associated with swollen ovaries Increasing abdominal distension (swelling) due to collection of fluid in the abdomen Nausea, vomiting and diarrhea Fluid collections in the base of the lungs in severed cases causing shortness of breath Increased coagulation of the blood potentially causing clots in the veins in severe cases Significant fluid and electrolyte imbalance in the body Dehydration in severe cases Appearance of cysts on the ovaries OHSS分度 轻度：轻度腹胀不适，可伴恶心、呕吐、腹泻；卵巢直径≤5cm。 中度OHSS：上述症状加重，伴体重增加4.5kg；超声检查可见腹水；卵巢直径5～10cm。 重度OHSS：出现临床证据的腹水和（或）胸水或呼吸困难，甚至出现低血容量、血液浓缩、高凝，直到发生少尿、休克、肾功能障碍；卵巢直径≥10cm。 高危因素 ·?? being under the age of 30 ·?? being underweight ·?? having PCOS ·? E2＞4000pg/ml ·? having a previous incidence of OHSS ·?? using high levels of hCG ·?? using GnRH agonists 预防措施 OHSS是医源性疾病。血清 e2和卵巢形态学变化可以反映卵巢的刺激程度 冻融胚胎移植和输注白蛋白 取卵前单侧卵巢部分卵泡穿刺 GnRHa类似物取代 hCG作促排卵治疗 Complications of Ovarian Hyperstimulation Syndrome OHSS can result in serious health complications. Severe cases of OHSS are rare, but they have been known to lead to permanent injury and even death. Possible complications include: ·?? twisting of the swollen ovaries