Effet comparatif de la vasopressine et de la noradrénaline sur la perfusion rénale évaluée par échographie de contraste dans un modéle de choc hémorragique murin

Abstract : Introduction - Acute kidney injury is an independent risk factor for mortality in haemorrhagic shock. The primary objective of our study was to compare the effects of fluid therapy without and with norepinephrine or vasopressin on renal hemodynamic, renal function, and renal histologic lesions in a resuscitated rat model of haemorrhagic shock. Method – Thirty male Wistar rats were assigned to three groups: 1/ only fluid resuscitation (2ml/kg/mn), 2/ fluid resuscitation with norepinephrine (NA) (3 μg/kg/mn) and 3/ fluid resuscitation with vasopressin (AVP) (0,02 UI/kg/mn). Blood was withdrawn through the carotid arterial line until the mean arterial blood pressure decreased to 40 mmHg for 90 minutes. Resuscitation was performed during 90 minutes. Finally, after blood transfusion rats were monitored for 60 minutes. Repeated measures were performed at each stage: aortic Doppler, renal Doppler, renal function, blood gas and contrast enhanced ultrasound. Results: In a model of hemorrhagic shock with renal tubular lesions, hemorrhage induced significant alteration of systemic hemodynamic (mean arterial pressure, aortic Doppler, lactate) and renal hemodynamic (renal Doppler and contrast enhanced ultrasound). The restoration of these parameters did not differ according to the resuscitation strategies. We observed a significant decrease (p <0.003) in the fluid resuscitation volume in the NA group (75.27 ml/kg [70.6-84.5]) compared to the fluid resuscitation group (109.3 ml/kg [98.2-137,1]). Discussion - The use of vasopressors in addition to fluid is not deleterious for systemic hemodynamic recovery, particularly for renal flow, and allows a similar correction of the lactate level. In kidney, hemodynamic parameters and histological injuries are unaffected by the use of a vasopressor. Conclusion - In a murine haemorrhagic shock model, the use of NA or AVP in addition to fluid has no deleterious effects on the restoration of aortic flow, lactate levels, and renal hemodynamics. Similarly, these two vasopressors did not increase kidney histologic lesions. These results, with the limitations of the experimental models, suggest that early use of these two vasopressors in addition to volume expansion in resuscitation of hemorrhagic shock would not be responsible for worsening renal lesions.
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Master Thesis
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Ottilie Trocheris-Fumery. Effet comparatif de la vasopressine et de la noradrénaline sur la perfusion rénale évaluée par échographie de contraste dans un modéle de choc hémorragique murin. Médecine humaine et pathologie. 2018. ⟨dumas-02088116⟩

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