标题：妊娠期糖尿病患者羊水量异常羊水成分分析及其对妊娠结局的影响

      作者：张雅，白润芳，李艳川，石紫云
    (陕西省人民医院产科，陕西 西安 710068)

      卷次： 2016年27卷20期

      【摘要】 目的 分析妊娠期糖尿病(GDM)患者羊水量异常羊水成分，并探讨其对临床妊娠结局的影响。
方法 选择 2013年2月至2015年8月期间在我院产科分娩的羊水量异常的133例GDM患者纳入研究，根据羊水
量的多少分成羊水过多组108例，羊水过少组25例，另选同期在医院正常分娩的羊水量正常的产妇30例作为对照
组，分析各组羊水成分，并随访至妊娠结束，分析患者羊水量异常的孕周分布情况及临床妊娠结局。结果 羊水过
多组孕妇的羊水量异常孕周主要分布在33~36周及>36周，羊水过少组孕妇的羊水量异常孕周主要分布在>36周；
羊水过少组孕妇的羊水成分中，Na+ (121.45±5.49) mmol/L、Ca2+ (1.58±0.16) mmol/L及Osm (241.23±10.09) mOsm/L
的水平明显低于对照组的(124.72±4.91) mmol/L、(1.68±0.17) mmol/L、(247.67±11.12) mOsm/L，而 Crea (223.36±
54.24) μmol/L及Glu (6.42±1.33) mmol/L的水平明显高于对照组的(191.98±29.64) μmol/L、(1.09±1.21) mmol/L，差异
均有统计学意义(P<0.05)；羊水过多组和羊水过少组孕妇的胎位异常(17.59%，20.00%)、胎儿窘迫(37.96%，24.00%)、
早产(23.15%，20.00%)和剖宫产率(87.96%，84.00%)均明显高于对照组的3.33%、6.67%、6.67%、33.33%，且羊水过多
组孕妇的胎盘早剥(18.52%)及产后大出血的发生率(17.59%)明显高于对照组的3.33%、3.33%，差异均有统计学意义
(P<0.05)。结论 GDM患者的羊水量异常主要分布在孕周33周以后，且羊水过多者占比较多，羊水成分变化较羊
水过少者更小，更易出现胎盘早剥及产后大出血等不良妊娠结局，值得临床重视。

      【关键词】 妊娠期糖尿病；羊水量异常；羊水成分；妊娠结局

      【中图分类号】 R714.256 【文献标识码】 A 【文章编号】 1003—6350（2016）20—3310—03


Amniotic fluid composition analysis of gestational diabetes mellitus patients with amniotic fluid volume
abnormality and its effect on pregnancy outcome.
ZHANG Ya, BAI Run-fang, LI Yan-chuan, SHI Zi-yun. Department
of Obstetrics, People's Hospital of Shaanxi Province, Xi'an 710068, Shaanxi, CHINA

【Abstract】 Objective To analyze the composition of amniotic fluid in gestational diabetes mellitus patients
with amniotic fluid volume abnormality and its effect on pregnancy outcome. Methods A total of 133 cases of gesta-
tional diabetes mellitus patients with abnormal amniotic fluid volume, who admitted to Department of Obstetrics of our
hospital from February 2013 to August 2015, were selected and divided into the amniotic fluid too much group (n=
108) and the amniotic fluid too little group (n=25) according to amniotic fluid volume. At the same period, 30 cases of
normal delivery of women with normal amniotic fluid volume were selected as the control group. Amniotic fluid com-
position was analyzed, and the patients were followed up to the end of pregnancy to analyze the gestational age distri-
bution and clinical pregnancy outcome. Results The gestational distribution of abnormal amniotic fluid in the amni-
otic fluid too much group was in 33~36 weeks and after 36 weeks, and the gestational distribution of abnormality am-
niotic fluid in the amniotic fluid too little group was after 36 weeks. Na+, Ca2 + and Osm levels in the amniotic fluid of
the amniotic fluid too little group were significantly lower than those of the control group, with (121.45±5.49) mmol/L vs
(124.72±4.91) mmol/L, (1.58±0.16) mmol/L vs (1.68±0.17) mmol/L, (241.23±10.09) mOsm/L vs (247.67±11.12) mOsm/L,
respectively, P<0.05. However, Crea and Glu levels in the amniotic fluid of in the amniotic fluid too little group
were significantly higher than those of the control group, with (223.36±54.24) μmol/L vs (191.98±29.64) μmol/L,
(6.42±1.33) mmol/L vs (1.09±1.21) mmol/L, P<0.05. The fetal abnormalities, fetal distress, preterm delivery and cesare-
an section ratio of the amniotic fluid too much group (17.59%, 37.96%, 23.15%, 87.96%, respectively) and the amniotic
fluid too little group (20.00%, 24.00%, 20.00%, 84.00%, respectively) were significantly higher than those of the control
group (3.33% , 6.67% , 6.67% , 33.33% ), P<0.05. The placental abruption (18.52% ) and postpartum hemorrhage ratio
(17.59%) of the amniotic fluid too much group was significantly higher than those of the control group (3.33%, 3.33%,
respectively), P<0.05. Conclusion The amniotic fluid volume abnormality of gestational diabetes mellitus patients are
mainly distributed in 33 gestational weeks and later, and patients with too much amniotic fluid account for a large por-
tion. The composition changes in amniotic fluid of the amniotic fluid too much group is smaller than that of the amniotic
fluid too little group, and patients with too