Navot D, Bergh P A, Laufer N
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, New York 10029.
Fertil Steril. 1992 Aug;58(2):249-61. doi: 10.1016/s0015-0282(16)55188-7.
To overview the world literature on ovarian hyperstimulation syndrome (OHSS) and modes of prevention and treatment of OHSS.
All the pertinent literature on OHSS, its prevention, and strategies for treatment were reviewed.
Key to prevention is proper identification of the population at risk, which includes women with either the hormonal or the morphological signs of polycystic ovarian disease, high serum estradiol (E2) before human chorionic gonadotropin (hCG) administration (E2 greater than 4,000 pg/mL), multiple follicular response (greater than 35), younger age, and lean habitus. When a high risk situation is recognized, ovulatory dose of hCG may be reduced, avoided (with cycle cancellation), or substituted by gonadotropin-releasing hormone or its agonist. Luteal support with hCG is to be bypassed. To minimize risk of OHSS, endogenous pregnancy-drived hCG may be eluded by judicious cryopreservation of all embryos. Last, follicular aspiration will allow higher levels of E2 and larger number of follicles to be matured with lesser risk of OHSS than conventional ovulation induction without follicular aspiration.
In-house for the severe and intensive care for the critical form. Meticulous fluid and electrolyte balance using both crystalloids and colloids (albumin) until hemoconcentration abates. Paracentesis is indicated for tight ascites, deteriorating kidney functions, and symptomatic relief. Diuretics may be prudently used once hemodilution is achieved. Dopamine drip may be used as a renal rescue, whereas heparin is indicated for thromboembolic phenomena and surgery reserved for abdominal catastrophies. Therapeutic interruption of an early gestation may be lifesaving when all other measures have failed.
Although severe and critical OHSS may not be completely avoided, early recognition of high-risk factors, judicious prevention schemes, and treatment strategies should reduce the complication and long-term sequelae of this iatrogenic syndrome.
综述关于卵巢过度刺激综合征（OHSS）及其预防和治疗方式的世界文献。
对所有关于OHSS、其预防及治疗策略的相关文献进行了综述。
预防的关键在于正确识别高危人群，其中包括患有多囊卵巢疾病激素或形态学体征、人绒毛膜促性腺激素（hCG）给药前血清雌二醇（E2）水平高（E2大于4000 pg/mL）、多个卵泡反应（大于35个）、年龄较小以及体型消瘦的女性。当识别出高危情况时，可减少、避免使用排卵剂量的hCG（取消周期），或用促性腺激素释放激素或其激动剂替代。应避免使用hCG进行黄体支持。为将OHSS风险降至最低，可通过审慎冷冻保存所有胚胎来避免内源性妊娠驱动的hCG。最后，与不进行卵泡抽吸的传统排卵诱导相比，卵泡抽吸可使E2水平更高、更多卵泡成熟，且OHSS风险更低。
对重症和危重症患者进行重症监护。使用晶体液和胶体液（白蛋白）精心维持液体和电解质平衡，直至血液浓缩缓解。对于严重腹水、肾功能恶化及症状缓解，需进行腹腔穿刺引流。一旦实现血液稀释，可谨慎使用利尿剂。多巴胺滴注可作为肾脏保护措施，而肝素适用于血栓栓塞现象，手术则用于治疗腹部严重病变。当所有其他措施均失败时，早期妊娠的治疗性中断可能挽救生命。
尽管严重和危重症OHSS可能无法完全避免，但早期识别高危因素、审慎的预防方案和治疗策略应能减少这种医源性综合征的并发症和长期后遗症。
