J.Jpn. Surg. Soc.. 57(12): 2030-2051, 1957
EXPERIMENTAL STUDIES ON THE HEPATIC CIRCULATION IN THE PROCESS OF DEVELOPMENT OF HEMORRHAGIC SHOCK INTO THE IRREVERSIBLE PHASE AND THE CONCERNED EFFECT OF ARTIFICIAL HIBERNATION
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Surgical Department, KEIO-GIJUKU University School of Medicine (Director; Prof. Nobukatsu SHIMADA) Yutaka UEHARA |
Procedures of artificial hibernation, controlled hypotension (Hexamethonium bromide) and splanchnicectomy, prior to the bleeding mentiond above, revealed remarkable preventive effect of shock. The mechanism of that favorable effect was studied experimentally from the stand point of the circulatory dynamics of the liver. The results obtained are as follows :
1) The abolition of liver function due to extreme reduction of the hepatic blood flow and resultant anoxia of the liver, both of which follow the decompensation of hemodynamics, seem to play an important role in the development of hemorrhagic shock into its irreversible phase.
2) Reduction of the hepatic blood flow due to massive hemorrhage is inevitable even under artificial hibernation. Chlorpromazine, however, inhibits both the increase of vascular resistance of the liver and the production of splanchnic pooling by blocking the autonomic nervous system. Thus, the drug inhibits circulatory disturbance of the liver to some extent from progressing into severer stage through stabilisation of the splanchnic circulatory system. This mechanism is considered to be significant in the rapid restoration of the hepatic blood flow after blood reinfusion. The insensibility of the liver tissue to anoxia which is acquired by blocking the hepatic autonomic system is also regared to be significant in inhibiting both the damage due to oligemic anoxia and the development of hemorrhagic shock.
3) Both Hexamethonium bromide and bilateral sections of the splanchnic nerve have preventive effect of shock. The mechanism is considered to be almost the same as the above described mechanism of artificial hibernation. The reason why the latter is more effective in preventing shock may owe to its some other favorable actions.
(author's abstract)
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