Changes In The Levels Of Inflammatory Markers And Lactic Acid After Device Closure Of Ventricular Septal Defect In Pediatric Patients

ObjectiveThe purpose of this study was to investigate the changes of inflammatory makers and lactic acid in pediatric patients underwent transthoracic device closure or surgical repair of ventricular septal defect(VSD).MethodsWe retrospectively collected clinical data of 314 pediatric patients in our hospital between October 2019 and October 2020.According to inclusion and exclusion criteria,propensity score matching(PSM)was used to eliminate the differences in basic data between the two groups.The white blood cells(WBC),C-reactive protein(CRP),and procalcitonin(PCT)were collected before operation and on postoperative day 1,postoperative day 2 and postoperative day 3.In addition,arterial lactic acid was collected on admission to the ICU and 6 hours after surgery,and 6-hour lactic acid clearance was calculated according to the formula.We also collected the highest lactate value during the ICU.After normal test,t-test was adopted for measurement data conforming to normal distribution,while Mann-Whitney Test U Test was used for those data which didn’t follow the normal distribution.Repeated-measures ANOVA was used to compare the inflammatory factors in the two groups at different time.Counting data were tested by chi-square test.Linear regression analysis and univariate regression analysis were used for correlation analysis.ResultsIn the basic data,there were significant statistical differences except for gender and body weight.Through the PSM,caliper value was set to 0.2,and 43 cases were successfully matched.There was no statistical significance in preoperative indicators.Patients in the transthoracic device closure group had shorter operation duration,ventilation duration,ICU duration and hospitalization duration,and less drainage volume and total hospitalization cost than those in the surgical repair group.In terms of inflammatory factors: 1)In the surgical repair group,WBC reached the peak value on the second postoperative day and then decreased,while in the device group,they reached the peak value on the first postoperative day and then decreased.In comparison between groups,there was no difference in these data on the first postoperative day.2)CRP significantly increased after surgery in both groups,reached the peak on the second postoperative day and then decreased,while there were significant statistical differences between the two groups on the postoperative third day.3)PCT significantly increased after surgery in both groups,reached the peak on the first postoperative day and then decreased,while there were significant statistical differences between the two groups on the postoperative first and second day.In terms of lactic acid,there was no significant difference between the two groups in the first lactic acid and the highest lactic acid after surgery,while the lactic acid value of the device group was significantly lower than that of the surgical repair group at 6h,and the 6h lactic acid clearance rate of the device group was 5.335 times faster than that of the repair group.In addition,the rate of lactate clearance at 6h after surgical repair was mainly related to the operation time,ventilation time and CPB time,while the rate of lactate clearance at 6h after transthoracic device closure was only related to the operation time.ConclusionAlthough the surgical trauma of transthoracic device closure of VSD is less than that of surgical repair of VSD,transthoracic device closure can still induce systemic inflammation similar to that of surgical repair.In postoperative lactic acid monitoring,there is no significant difference in the initial and maximum lactic acid levels between the two groups.However,the lactic acid clearance rate was 5 times faster than that of surgical repair 6 hours after transthoracic device closure.