妊娠期尿崩症七例临床特点分析  

Clinical characteristics of 7 patients with gestational diabetes insipidus

作　　者：吴丽群[1] 熊春秋[1] 吴敏[1] 董若琳[1] 陈云琴[1] 高洁 陈藕景[3] 黄引平[1] 

机构地区：[1]温州医学院附属第一医院妇产科,325000 [2]浙江省温州市中西医结合医院妇产科 [3]浙江省台州医院妇产科

出　　处：《中华妇产科杂志》2008年第4期266-268,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨妊娠期尿崩症的临床特征、治疗方法和预后。方法对温州医学院附属第一医院、温州市中西医结合医院和浙江省台州医院1993年6月至2006年6月间收治的7例妊娠期尿崩症患者的临床资料进行回顾性分析。结果7例妊娠期尿崩症患者均有烦渴、多尿、多饮症状，24h尿量平均在11—13L之间，均为低比重尿，平均尿比重为1．003±0．003，24h饮水量平均在10—12L之间。7例患者中有3例口服醋酸去氨加压素、3例口服氢氯噻嗪、1例口服螺内酯治疗，分别于产后7d至3个月烦渴、多尿、多饮症状消失，24h尿量降至1000—2000ml之间，尿比重在1．015～1．025间，血钠水平为135～147mmol／L，平均病程52d。7例患者共分娩8例新生儿，均存活，其中2例转新生儿科治疗（转科原因为1例因子痫而早产；另1例为双胎之一发生双肾积水），早产儿于新生儿科住院3周后出院，肾积水新生儿产后2周双肾积水消失，全部新生儿随访至分娩后42d未发现明显异常。结论妊娠期尿崩症是一种罕见的妊娠合并内分泌疾病，以烦渴、多饮、多尿、低比重尿、电解质紊乱为主要临床表现，多为一过性症状。醋酸去氨加压素是首选治疗妊娠期尿崩症药物，次选为氢氯噻嗪。如能早期诊断及正确处理，则母婴预后良好。Objective To investigate the clinical feature, treatment and prognosis of both the mother and the fetus with gestational diabetes insipidus. Methods A total of 7 cases of gestational diabetes insipidus collected in the First Affiliated Hospital of Wenzhou Medical College, Wer/zhou Combination of Traditional Chinese Medicine with Western Medicine Hospital, and Zhejiang Taizhou Hospital from June 1993 to June 2006 were analyzed retrospectively. Results Seven cases symptoms all characterized by excessive thirst polydipsia and polyuria. The average 24 h urinary output was between 11 L to 13 L and manifested of hypobaricuria. After effective treatment （three cases were treated with 1-deamino-8-D-arginine vasopressin, another three patients were managed with hydrochlorothiazide, and the last one was cured with antisterone）, seven patients with gestational diabetes insipidus did not have any severe consequences. Their symptoms of excessive thirst, polyuria, and polydypsia disappeared from 7 days to 3 months after parturition. Urinary volume returned to normal standard of 1000 -2000 ml during 24 hours. Specific gravity of urine recovered normally between a range 1. 015 - 1. 025 and serum sodium recovered between 135 - 147 mmol/L The average duration of illness was 52 days. Eight newborn infants survived. Two of them were sent to neonatal intensive care unit for treatment. One was because of premature delivery caused by antepartum eclampsia, and the other case was one of the twins who had hydronephrosis. The baby of the first case left hospital after 3 weeks＇ treatment. The latter one＇s symptom disappeared 2 weeks after delivery. No obvious symptom was discovered among all the babies through follow-up telephone calls 42 days after childbirth. Conclusion Gestational diabetes insipidus is a rare endocrinopathy complicating pregnancy. This disorder is characterized by excessive thirst, polydypsia, polyuria, hypobaric urine and electrolyte disturbances usually manifesting in the third trimester of pregnancy or puerper

关 键 词：妊娠并发症 尿崩症 妊娠结局 

分 类 号：R686[医药卫生—骨科学]