【摘要】 目的：探讨不同宫腔灌注方案在反复胚胎种植失败患者冻融胚胎移植中的应用价值，以期明确最佳的宫腔灌注方案，为改善患者妊娠结局提供依据。方法：纳入2020年1月-2021年12月南昌市生殖医院收治的300例胚胎种植反复失败且要行冻融胚胎移植患者为研究对象，以随机数字表法分为五组，每组60例，前三组设为试验组，均于冻融胚胎移植前3 d行宫腔灌注治疗，宫腔内灌注方案选用三种，分别为宫腔灌注人绒毛膜促性腺激素（hCG）、宫腔灌注粒细胞集落刺激因子（G-CSF）、宫腔灌注外周血单核细胞（PBMCs），依据宫腔灌注药物的不同将试验组分为hCG组、G-CSF组、PBMCs组。第四组同期宫腔灌注生理盐水，为安慰剂组，第五组不开展宫腔灌注治疗，为空白对照组。统计各组治疗后子宫内膜血流分型及参数[搏动指数（PI）、阻力指数（RI）]；开展随访统计，比较各组妊娠情况（胚胎着床率、临床妊娠率、流产率、持续妊娠率）。结果：五组患者年龄、BMI、不孕年限、移植失败次数等一般基线资料比较，差异均无统计学意义（P>0.05）。hCG组、G-CSF组、PBMCs组及安慰剂组胚胎着床率、临床妊娠率、持续妊娠率均高于空白对照组，差异均有统计学意义（P<0.05）。治疗后h CG组、G-CSF组、PBMCs组及安慰剂组PI、RI均低于空白对照组；子宫内膜血流灌注Ⅰ型占比均低于空白对照组，差异均有统计学意义（P<0.05）。hCG组、G-CSF组、PBMCs组的胚胎着床率、临床妊娠率、流产率、持续妊娠率互相比较，差异均无统计学意义（P>0.05）。结论：胚胎种植失败患者应用不同宫腔灌注方案均可达到改善子宫内膜容受性，以及提高胚胎着床率、临床妊娠率、持续妊娠率的目的。更多还原

【Abstract】 Objective: To explore the application value of different intrauterine perfusion schemes in frozen thawed embryo transfer of patients with repeated embryo implantation failure, so as to determine the best intrauterine perfusion scheme and provide basis for improving the pregnancy outcome of patients. Method: A total of 300 patients with recurrent failure of embryo implantation and frozen thawed embryo transfer who were admitted to Nanchang Reproductive Hospital from January 2020 to December 2021 were included as the research object. They were randomly divided into five groups, 60 cases in each group. The first three groups were set as the experimental group, and all were treated with intrauterine infusion 3 days before frozen thawed embryo transfer. Three intrauterine infusion schemes were selected, namely intrauterine infusion of human chorionic gonadotropin(hCG), granulocyte colony-stimulating factor(G-CSF) and peripheral blood mononuclear cells(PBMCs) were perfused into uterine cavity. The experimental groups were divided into hCG group, G-CSF group and PBMCs group according to the different drugs perfused into uterine cavity. The fourth group was injected with normal saline into the uterine cavity at the same time, which was a placebo group. The fifth group was a blank control group without uterine cavity perfusion treatment. The endometrial blood flow types and parameters [pulsatility index(PI), resistance index(RI)]after treatment were counted. The follow-up statistics was carried out, and the pregnancy status of patients in each group [embryo implantation rate, clinical pregnancy rate, abortion rate, persistent pregnancy rate] were compared.Result: There were no significant differences between the five groups in terms of age, BMI, infertility years,transplant failure times and other general baseline data(P>0.05). The embryo implantation rate, clinical pregnancy rate and persistent pregnancy rate in hCG group, G-CSF group, PBMCs group and placebo group were higher than those in the blank control group, with a statistically significant difference(P<0.05). PI and RI in hCG group,G-CSF group, PBMCs group and placebo group were lower than those in the blank control group after treatment; the proportion of endometrial blood flow perfusion type Ⅰ was lower than that of the blank control group, the differences were statistically significant(P<0.05). There were no significant differences in embryo implantation rate, clinical pregnancy rate, abortion rate and persistent pregnancy rate among hCG group, G-CSF group and PBMCs group(P>0.05). Conclusion: Different intrauterine perfusion protocols can improve endometrial receptivity, embryo implantation rate, clinical pregnancy rate and persistent pregnancy rate.更多还原