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在体外受精(in vitro fertililization,IVF)周期中,血栓栓塞是卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)中最严重的并发症,而促性腺激素是诱发血栓栓塞的最主要原因。易栓症标志分子的作用存在争议。在IVF周期中,血栓的发病率为0.11%,致死率为1/45 000~1/500 000。血栓通常发生在静脉(67%~81%),多为头颈部,动脉血栓(19%~33%)多发于脑部。精确识别OHSS高危患者,对其选择恰当的促排卵方案和促性腺激素剂量,并结合冷冻全部卵子或胚胎后行冻融胚胎移植,将显著降低高危患者血栓栓塞的风险。一旦血栓栓塞被早期确诊,使用抗凝剂肝素进行预防就显得尤为关键。但是,减少卵巢刺激后血栓形成风险的最有效方法是识别OHSS高危患者并及时采取预防措施。本文分析促排卵过程中发生OHSS患者血栓形成的发病机理及临床表现,并为此提出实用的预防和治疗方案。
Thromboembolism is the most serious complication of ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) cycles, and gonadotropin is the leading cause of thromboembolism. The role of thrombolytic markers is controversial. In the IVF cycle, the incidence of thrombosis was 0.11% and the lethality was 1/45 000 to 1/500 000. Thrombus usually occurs in the veins (67% ~ 81%), mostly head and neck, arterial thrombosis (19% to 33%) in the brain. Precise identification of high-risk OHSS patients, the appropriate choice of ovulation induction and gonadotropin dosage, combined with freezing all eggs or embryos after the freeze-thaw embryo transfer, will significantly reduce the risk of thromboembolism in high-risk patients. Once thromboembolism is diagnosed early, the use of anticoagulant heparin for prevention is particularly crucial. However, the most effective way to reduce the risk of thrombosis after ovarian stimulation is to identify those at high risk of OHSS and take timely precautions. This article analyzes the pathogenesis and clinical manifestations of thrombosis in patients with OHSS during ovulation induction, and put forward practical prevention and treatment programs for this.