[Effects of Tham, isoprenaline and propranolol on the blood flow and vascular resistance of the liver after clamping of the afferent and efferent vessels. Relation to splanchnic shock]. / Effets du Tham, de l'isoprénaline et du Propranolol sur le débit et les résistances du foie après clampage des vaisseaux afférents et efférents. Relations avec le choc splanchnique

To determine the roles of portal circulation and the hepatic arteries during states of shock, the authors studied on 38 dogs, the effects of 30 minutes clamping of the sub-diaphragmatic part of the inferior vena cava, the portal vein and the hepatic artery, either together or successively. They measured the pressure in these various vessels, the transhepatic flow, using Xenon133, and calculated the intra-hepatic resistance. The animals were then treated with Tham, isoprenaline and propanolol. Tolerance to clamping was improved significantly when the animals were treated with the association of these drugs. The portal pressure and the systemic arterial pressure, rapidly returned to normal. This was also the case with hepatic, venous or arterial blood flow. There was a remarkable stability between the sinusoidal and biliary resistances, compared with disturbances in control groups. The already well known beneficial effect of Tham was increased by the apparently paradoxical association of isoprenaline and propranolol. In fact, with this dosage, they counter-balanced their reciprocal disadvantages. Finally, a study of blood flow and vascular resistance in the liver, suggests the existence of two components in splanchnic shock, hepatic and visceral.

Effects of tham, isoprenaline and propranolol on blood flow and vascular resistances of the liver after in- and outflow occlusion. Relation with the splanchnic shock.

The responsibility of the portal and the hepatic artery circulations during shock states has been established by studying the effects of a 15-min occlusion of two of the following blood vessels on 23 dogs: inferior vena cava below the diaphragm, portal vein and hepatic artery. Intrahepatic vascular resistances were computed from blood pressure records in these vessels and transhepatic blood flow studies using the 133Xe clearance method. The animals were treated with THAM, plasmagel, isoprenaline, and propranolol. The tolerance of the occlusion is significantly improved when the animals are treated with the association of the four drugs. The portal and the systemic arterial blood pressures return to normal more promptly. Sinusoid and peribiliary resistances are remarkably stable if compared to the changes occurring in the control animals. The well-known benefit of THAM is improved by the apparently paradoxical association of isoprenaline and propranolol. In fact, at the doses which have been used, they counterbalance their mutual disadvantages. Finally, the analysis of the hepatic blood flow rates and vascular resistances suggests that the splanchnic shock has two components: hepatic and visceral.