Balasch J, Arroyo V, Fábregues F, Saló J, Jiménez W, Paré J C, Vanrell J A
Department of Obstetrics and Gynecology, Hospital Clínic i Provincial, Barcelona, Spain.
Ann Intern Med. 1994 Jul 1;121(1):27-33. doi: 10.7326/0003-4819-121-1-199407010-00005.
To evaluate systemic hemodynamics, endogenous vasoactive neurohormonal factors (renin-angiotensin and sympathetic nervous systems, antidiuretic hormone, atrial natriuretic factor, and renal prostaglandins), and renal function in the severe ovarian hyperstimulation syndrome.
Prospective longitudinal study.
Assisted-reproduction unit of a tertiary care hospital in Barcelona, Spain.
31 consecutive patients having in vitro fertilization with development of ascites because of severe ovarian hyperstimulation syndrome.
Mean arterial pressure; cardiac output; peripheral vascular resistance; hematocrit concentration; renal function; plasma renin activity; plasma aldosterone, norepinephrine, antidiuretic hormone, and atrial natriuretic peptide determinations; and urinary excretion of prostaglandin E2 and 6-keto-prostaglandin-F1 were measured during the syndrome and 4 to 5 weeks after recovery (baseline).
During the syndrome, patients showed increased hematocrits (mean of the paired difference, 0.047; 95% CI, 0.029 to 0.064), decreased mean arterial pressure (-16.6 mm Hg; CI, -19.8 to -13.6), increased cardiac output (2.6 L/min; CI, 2.13 to 3.17), and reduced peripheral vascular resistance (-709 dyne/s.cm-5;CI, -792 to -627). This was accompanied by marked increases of plasma renin (14.4 ng/L.s; CI, 9.87 to 18.90), norepinephrine (1.857 nmol/L; CI, 0.533 to 3.161), antidiuretic hormone (3.3 pg/mL; CI, 1.89 to 4.71), and atrial natriuretic peptide levels (9.7 fmol/mL; CI, 6.1 to 13.2). Hemoconcentration developed in 16 patients (mean of the paired difference in hematocrit concentration, 0.082; CI, 0.063 to 0.101) but not in 15 others (0.009; CI, 0.003 to 0.021). Both groups showed similar values for arterial pressure, cardiac output, and peripheral vascular resistance, but patients with hemoconcentration had higher (P < 0.05) levels of renin (mean, 20.97 ng/L.s[CI, 13.3 to 28.63] compared with 7.83 ng/L.s[CI, 4.08 to 11.58]), norepinephrine (3.907 nmol/L [CI, 3.057 to 4.757] compared with 2.417 [CI, 2.035 to 2.799]), and antidiuretic hormone (6.0 pg/mL [CI, 4.1 to 7.9] compared with 2.4 [CI, 1.7 to 3.03]).
In addition to increased capillary permeability, severe ovarian hyperstimulation syndrome is consistently associated with arteriolar vasodilation. The simultaneous occurrence of these disorders leads to hyperdynamic circulatory dysfunction with marked stimulation of the sympathetic nervous system, renin-angiotensin system, and antidiuretic hormone.
评估重度卵巢过度刺激综合征患者的全身血流动力学、内源性血管活性神经激素因子（肾素 - 血管紧张素和交感神经系统、抗利尿激素、心房利钠因子及肾前列腺素）及肾功能。
前瞻性纵向研究。
西班牙巴塞罗那一家三级护理医院的辅助生殖科。
31例因重度卵巢过度刺激综合征出现腹水而行体外受精的连续患者。
在综合征期间及恢复后4至5周（基线）测量平均动脉压、心输出量、外周血管阻力、血细胞比容浓度、肾功能、血浆肾素活性、血浆醛固酮、去甲肾上腺素、抗利尿激素及心房利钠肽水平，以及前列腺素E2和6 - 酮 - 前列腺素 - F1的尿排泄量。
在综合征期间，患者血细胞比容升高（配对差值均值为0.047；95%可信区间为0.029至0.064），平均动脉压降低（-16.6 mmHg；可信区间为-19.8至-13.6），心输出量增加（2.6 L/min；可信区间为2.13至3.17），外周血管阻力降低（-709达因/秒·厘米⁻⁵；可信区间为-792至-627）。同时伴有血浆肾素（14.4 ng/L·秒；可信区间为9.87至18.90）、去甲肾上腺素（1.857 nmol/L；可信区间为0.533至3.161）、抗利尿激素（3.3 pg/mL；可信区间为1.89至4.71）及心房利钠肽水平显著升高（9.7 fmol/mL；可信区间为6.1至13.2）。16例患者出现血液浓缩（血细胞比容浓度配对差值均值为0.082；可信区间为0.063至0.101），另15例未出现（0.009；可信区间为0.003至0.021）。两组患者的动脉压、心输出量及外周血管阻力值相似，但血液浓缩患者的肾素（均值为20.97 ng/L·秒[可信区间为13.3至28.63]，而未浓缩患者为7.83 ng/L·秒[可信区间为4.08至11.58]）、去甲肾上腺素（3.907 nmol/L [可信区间为3.057至4.757]，而未浓缩患者为2.417 [可信区间为2.035至2.799]）及抗利尿激素（6.0 pg/mL [可信区间为4.1至7.9]，而未浓缩患者为2.4 [可信区间为1.7至3.03]）水平更高（P < 0.05）。
除毛细血管通透性增加外，重度卵巢过度刺激综合征始终与小动脉血管舒张相关。这些病症同时出现导致高动力循环功能障碍，并伴有交感神经系统、肾素 - 血管紧张素系统及抗利尿激素的显著激活。
