Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China.
BMC Cardiovasc Disord. 2022 May 18;22(1):228. doi: 10.1186/s12872-022-02666-x.
The percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic inflammatory markers' levels after PDA in children are not fully reported.
We have conducted a retrospective analysis of the medical records of 385 pediatric patients in our hospital from January 2017 to December 2019. The patients were distributed into five groups. The first four (A, B, C and D) included patients divided by the type of the surgical closure methods, namely ligation, clamping, ligation-combined suturing and ligation-combined clamping, respectively. The fifth group E comprised of percutaneous device PDA patients. All recorded medical and trial data from the five groups were statistically studied.
No serious complications in the patients regardless of the classification group were reported. Our results suggested that there were no considerable differences between the groups at the baseline (with all P > 0.05). Group E demonstrated a significantly smaller operative time (42.39 ± 3.88, min) and length of hospital stay (LOS) (4.49 ± 0.50, day), less intraoperative blood loss (7.12 ± 2.09, ml) while on the other hand, a higher total hospital cost (24,001.35 ± 1152.80, RMB) than the other four groups (with all P < 0.001). Interestingly, the comparison of the inflammatory factors such as white blood cells (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), as well as the myocardial injury markers (CKMB and troponin I) did not show a significant increase (P > 0.05) among the four groups. On the contrary, when the aforementioned factors and markers of all the surgical groups were compared to those in group E, we observed significantly higher speed and magnitude of changes in group E than those in groups A, B, C, and D (with all P < 0.001).
Although the percutaneous device closure of PDA is more comforting and drives fast recuperation in comparison to conventional surgery, it provokes myocardial injury and overall inflammation. Timely substantial and aggressive intervention measures such as the use of antibiotics before operation and active glucocorticoids to suppress inflammation and nourish the myocardium need be applied if the myocardial and inflammatory markers are eminent.
动脉导管未闭（PDA）的经皮器械封堵术在临床实践中得到广泛应用，然而，关于儿童 PDA 后心肌损伤和全身炎症标志物水平变化的完整数据尚未完全报道。
我们对 2017 年 1 月至 2019 年 12 月我院 385 例儿科患者的病历进行了回顾性分析。患者分为五组。前四组（A、B、C 和 D）分别为结扎、夹闭、结扎缝合和结扎夹闭的手术闭合方法，第五组 E 为经皮器械 PDA 患者。对五组所有记录的医学和试验数据进行了统计学研究。
无论分类组如何，患者均未报告严重并发症。我们的结果表明，各组在基线时无明显差异（均 P>0.05）。E 组手术时间（42.39±3.88 分钟）和住院时间（LOS）（4.49±0.50 天）明显缩短，术中出血量（7.12±2.09ml）减少，另一方面，总住院费用（24001.35±1152.80 元）高于其他四组（均 P<0.001）。有趣的是，与其他四组相比，白细胞（WBC）计数、C 反应蛋白（CRP）、降钙素原（PCT）和白细胞介素-6（IL-6）等炎症因子以及肌酸激酶同工酶（CKMB）和肌钙蛋白 I 等心肌损伤标志物的比较并未显示出明显增加（P>0.05）。相反，当将上述所有手术组的因素和标志物与 E 组进行比较时，我们观察到 E 组的变化速度和幅度明显高于 A、B、C 和 D 组（均 P<0.001）。
与传统手术相比，经皮器械封堵 PDA 更为舒适，恢复更快，但会引起心肌损伤和全身炎症。如果心肌和炎症标志物明显，需要及时采取抗生素术前应用和积极糖皮质激素抑制炎症和营养心肌等大量积极的干预措施。
