Les effets des substances vasoactives sur les perturbations hémodynamiques, systémiques et splanchniques induites par les états de choc et la cirrhose

Abstract : The impairment of vascular regulatory mechanisms observed in cirrhosis and shock situations, reduces the effectiveness of vasoactive substances used in treatments. The aim of this study is the hemodynamic, systemic and splanchnic assessments of vasoactive molecules proposed for the treatment of septic shock, hemorrhagic shock and cirrhosis complications (hydrogen sulfide [H2S], terlipressin [TP] and norepinephrine [NE]). In a model of ischemia/reperfusion (I/R), sepsis has no particular impact on the kidney since renal blood flow varies in response to mean arterial blood pressure variations, including an auto-regulation phenomenon. Sepsis is very rapidly associated with hypervelocity of blood flow in peritubular capillaries and renal dysfunction, both of wich are reserved by NE infusion. In hemorrhagic shock model controlled and resuscitated by Gelofusin® perfusion, we demonstrated that inhibition of endogenous H2S worsening renal dysfunction due to decreased renal peritubular microcirculatory velocities and promotes capillary leak syndrome. While the exogenous administration of H2S, could cause a negative feedback on the activity of the principal enzyme of endogenous H2S production, the CSE. During portal hypertension by cirrhosis in rats, NE increases the portal venous pressure, at low doses, and is more efficient than vasopressin on the portal veins of cirrhotic rats in vitro. However TP significantly reduces the mesenteric artery blood flow and the portal vein pressure. Taken together, TP could reduce the variceal bleeding risk associated with cirrhosis in comparison to NE.
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Maher Tabka. Les effets des substances vasoactives sur les perturbations hémodynamiques, systémiques et splanchniques induites par les états de choc et la cirrhose. Médecine humaine et pathologie. Université d'Angers, 2015. Français. ⟨NNT : 2015ANGE0064⟩. ⟨tel-02174760⟩

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