CAJ | 학술논문

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,24 h尿量平均在11-13 L之间,均为低比重尿,平均尿比重为1.003±0.003,24 h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7 d至3个月烦渴、多尿、多饮症状消失,24 h尿量降至1000～2000 ml之间,尿比重在1.015～1.025间,血钠水平为135～147 mmol/L,平均病程52 d.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42 d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.
목적 탐토임신기뇨붕증적림상특정、치료방법화예후.방법 대온주의학원부속제일의원、온주시중서의결합의원화절강성태주의원1993년6월지2006년6월간수치적7례임신기뇨붕증환자적림상자료진행회고성분석.결과 7례임신기뇨붕증환자균유번갈、다뇨、다음증상,24 h뇨량평균재11-13 L지간,균위저비중뇨,평균뇨비중위1.003±0.003,24 h음수량평균재10-12L지간.7례환자중유3례구복작산거안가압소、3례구복경록새진、1례구복라내지치료,분별우산후7 d지3개월번갈、다뇨、다음증상소실,24 h뇨량강지1000～2000 ml지간,뇨비중재1.015～1.025간,혈납수평위135～147 mmol/L,평균병정52 d.7례환자공분면8례신생인,균존활,기중2례전신생인과치료(전과원인위1례인자간이조산;령1례위쌍태지일발생쌍신적수),조산인우신생인과주원3주후출원,신적수신생인산후2주쌍.신적수소실,전부신생인수방지분면후42 d미발현명현이상.결론 임신기뇨붕증시일충한견적임신합병내분비질병,이번갈、다음、다뇨、저비중뇨、전해질문란위주요림상표현,다위일과성증상.작산거안가압소시수선치료임신기뇨붕증약물,차선위경록새진.여능조기진단급정학처리,칙모영예후량호.
Objective To investigate the clinical feature,treatment and prognosis of both themother 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,Wen'zhou Combination ofTraditional Chinese Medicine with Western Medicine Hospital,and Zhejiang Taizhou Hospital from June 1993to June 2006 were analyzed retrospectively.Resuits 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 Theaverage 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 puerperium.This is a transient syndrome.The first treatment of choice in patients with gestational diabetes insipidus is 1-deamino-8-D-arginine vasopressin and the second-choice is hydrochlorothiazide.Early diagnosis and appropriate management of the disease may reduce the hazard forboth the mother and the fetus during perinatal period.