Physiopathologie du retour veineux systémique au cours de l’insuffisance circulatoire aiguë
Tóm tắt
Le retour veineux systémique représente le débit de sang acheminé de la périphérie du système veineux systémique vers le coeur droit. À l’équilibre, le retour veineux systémique est égal au débit cardiaque, les systèmes veineux et artériels fonctionnant en série. Cependant, à l’inverse du système artériel, le système veineux est un système capacitif dont la compliance est élevée. Il comporte un volume non contraint, qui constitue un réservoir sanguin recrutable via la stimulation sympathique endogène ou exogène (administration de substances vasoconstrictrices). Le modèle de Guyton permet d’identifier les déterminants du retour veineux systémique: la pression systémique moyenne, la pression de l’oreillette droite et les résistances au retour veineux systémique. De façon récente, des méthodes ont été mises au point pour étudier au lit du patient de soins intensifs le retour veineux et pour estimer ses déterminants. Ainsi, une approche physiopathologique des états d’insuffisance circulatoire par le biais de l’étude du retour veineux permet une description complète des mécanismes qui les sous-tendent et l’analyse des effets des principaux traitements utilisés dans ce contexte.
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