Abstract
Twenty-one patients with acute pancreatitis underwent evaluation of cardiovascular function and oxygen consumption; 5 of those who were critically ill had a further study of hormonal metabolism. The evaluation of hemodynamic parameters was made using a computer-based cardiovascular program developed by Siegel et al. During the initial phase of the disease a reduction in vascular tone (relating cardiac index with total peripheral resistance) represented the basic abnormality seen in all patients, while a depression in ventricular function (relating left ventricular stroke work with central venous pressure) was observed in more than 40% of patients. With the progression of pancreatitis, cardiovascular monitoring identified a time, 5 days after admission, in which a clear deterioration of the hemodynamic parameters occurred. Beyond 5 days, all patients developed a hyperdynamic state with mild to severe deficiency of oxygen extraction. In the most seriously ill patients, oxygen consumption fell and peripheral shunting increased in a similar manner to that observed in septic and cirrhotic patients. At this time a Survival Index permitted recognition of those patients at high risk of rapid deterioration who might benefit from emergency surgical therapy. In 5 patients who developed a hyperdynamic unbalanced state, a marked reduction in oxygen consumption was associated with significantly increased serum levels of insulin, glucagon, aromatic amino acids, octopamine, and phenylethanolamine. While false neurotransmitters may be invoked in explanation of peripheral vascular abnormalities, the cause of impairment in oxygen extraction remains unclear.
Résumé
Chez 21 malades souffrant de pancréatite aigüe, nous avons étudié les fonctions cardiovasculaires et la consommation d'oxygène; chez 5 d'entre eux, gravement atteints, nous avons de plus étudié le métabolisme hormonal. L'analyse des paramètres hémodynamiques a été faite en suivant un programme d'ordinateur développé par Siegel et al. Pendant la phase initiale de la maladie, on observe chez tous les malades une réduction du tonus vasculaire (rapport entre index cardiaque et résistance périphérique) et chez plus de 40% d'entre eux une dépression de la fonction ventriculaire (rapport entre éjection ventriculaire gauche et pression veineuse centrale). Lorsque la pancréatite progresse, le monitoring cardiovasculaire montre qu'au 5è jour se produit une détérioration des paramètres hémodynamiques. Après le 5è jour apparait chez tous les malades un état hyperdynamique avec déficit modéré ou grave de l'extraction d'oxygène. Chez les patients les plus gravement atteints, la consommation d'oxygène s'effondre et les shunts périphériques augmentent, d'une façon comparable à ce que l'on peut observer dans les états septiques et chez les cirrhotiques. A ce stade de la maladie, un index de survie permet de définir les patients qui risquent de se détériorer rapidement et qui peuvent bénéficier d'une chirurgie d'urgence. Chez 5 malades en état hyperdynamique non équilibré, nous avons trouvé une réduction importante de la consommation d'oxygène associée à une élévation significative des taux sériques d'insuline, de glucagon, d'acides aminés aromatiques, d'octopamine et de phényléthanolamine. Les perturbations vasculaires périphériques sont peut-être causées par de faux neurotransmetteurs, mais nous n'avons aucune explication satisfaisante pour le déficit d'extraction d'oxygène.
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Di Carlo, V., Nespoli, A., Chiesa, R. et al. Hemodynamic and metabolic impairment in acute pancreatitis. World J. Surg. 5, 329–335 (1981). https://doi.org/10.1007/BF01657989
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DOI: https://doi.org/10.1007/BF01657989