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Liberty Tua Panahatan
"[ABSTRAK
Tujuan dari penelitian ini adalah untuk menilai dampak dari preopratif incentive spirometry terhadap komplikasi paru dan uji fungsi paru di antara pasien dengan operasi abdomen mayor Pasien yang menjalani operasi mayor abdomen tanpa riwayat penyakit paru secara acak dibagi menjadi dua kelompok: kelompok latihan dan kelompok kontrol. Kelompok Latihan diberi 15 menit latihan empat kali sehari selama 2 hari sebelum operasi. Kelompok kontrol tidak menerima latihan. Pengukuran fungsi paru baseline dan pasca operasi diambil pada kedua kelompok. Fungsi paru pasca operasi diukur dari hari pertama sampai hari ketujuh. Semua pasien dinilai untuk komplikasi paru pasca operasi oleh ahli pulmonologi.
Kami merekrut 23 pasien dalam setiap kelompok. Insiden komplikasi paru adalah 56,5% pada kelompok kontrol dan tidak ada komplikasi yang ditemukan di antara pasien pada kelompok latihan. Ada penurunan yang signifikan dari komplikasi paru pada kelompok exrcise (p <0,001). Ada penurunan signifikan dari atelektasis (p <0,01), pneumonia (p 0,025), Hipokemia (p 0,005). Incentive spirometry memiliki efek perlindungan dengan resiko relative (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) untuk komplikasi pada kelompok kontrol adalah 3,3 (OR 3,30 CI 95% 1,97-5,54) pada komplikasi paru. Dalam hal fungsi paru, kami menemukan peningkatan yang signifikan pada Vital Capacity (dari 2336,96 + 722,56 mL ke 2541,30 + 718,78 mL dengan p <0,01) dan Force Vital Capacity (dari 2287,39 + 706 , 11 untuk 2469,57 + 676,10 dengan p <0,01) setelah latihan. Sebagai kesimpulan, preoperatif incentive spirometry dapat menurunkan insiden komplikasi paru.ABSTRACT The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending
pulmonologist.
We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.
As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. , The aim of this study is to assess the impact of preoperative incentive spirometry on pulmonary complication and pulmonary fuction test among patients with major abdominal surgery. Petient underwent major abdominal surgery without any history pulmonary disease were randomized into two group: the exercise group and the control group. Exercise group were given 15 minute exercise four times daily for 2 days prior to surgery. The control group receive no exercise. Baselie and post-surgery pulmonary function measurement were taken in both groups. Post surgery pulmonary function measure in first until seventh day after surgery. All patients were assessed for post operative pulmonary complication by attending
pulmonologist.
We recruited 23 patients in each group. The incidence of pulmonary complication was 56,5% in the control group and no complication were found among patient in the exercise group. There was a significant decrease of pulmonary complication in exrcise group (p <0,001). There were signigicant decrease of atelectasis (p <0,01), pneumonia (p 0,025), Hipoxemia (p 0,005). Incentive spirometry has protective effect with relative risk (RR) 0,11 (CI 95% 0,02-0,74). Odds Ratio (OR) for complication in control group was 3,3 (OR 3,30 CI 95% 1,97-5,54) on pulmonary complication. In terms of pulmonary function, we found significant increase on Vital Capacity (from 2336,96 + 722,56 mL to 2541,30 + 718,78 mL with p<0,01) and Force Vital Capacity (from 2287,39 + 706,11 to 2469,57 + 676,10 with p<0,01) after exercise.
As conclusion, preoperative incentive spirometry may decrease incidence of pulmonary complication. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Sidharta Kusuma Manggala
"Pembedahan abdomen atas berkaitan disfungsi diafragma. Disfungsi diafragma merupakan penyebab PPC (postoperative pulmonary complication). Terapi oksigen konvensional (TOK) merupakan terapi standar pada pasien pasca pembedahan abdomen atas. Terapi HFNC (high-flow nasal cannula) memiliki berbagai mekanisme yang berbeda dengan TOK dan dipikirkan dapat membantu fungsi diafragma pascapembedahan abdomen atas. Studi ini bertujuan untuk membandingkan kemampuan HFNC terhadap TOK dalam mempertahankan fungsi diafragma pascapembedahan abdomen atas. Studi ini dilakukan di RSUPN Dr. Cipto Mangunkusumo dari November 2018 – September 2019. Tujuh puluh satu pasien dibagi secara acak menjadi dua kelompok: kelompok TOK dan HFNC. Enam puluh enam pasien mendapat intervensi setelah ekstubasi di ICU (intensive care unit). Seluruh subjek dilakukan pencatatan nilai DTF (diaphragm thickening fraction) menggunakan ultrasonografi, ΔTIV (perubahan tidal impedance variance), ΔEELI-G dan ΔEELI-ROI (perubahan end expiratory lung impedance global dan region of interest) menggunakan EIT (electrical impedance tomography), PaO2 dan PaCO2 (tekanan parsial oksigen dan karbon dioksida arteri) secara berkala pada dua seri. Efek samping dan keluhan yang muncul dicatat dan ditatalaksana. Total 66 subjek disertakan dalam bivariat menggunakan t-test dan mann whitney, sedangkan analisis tren menggunakan general linear model atau generalized estimating equation. Durasi ventilasi mekanik di ICU, persentase prediksi mortalitas dan skor P-POSSUM antara kedua kelompok berbeda signifikan (p=0,003; 0,001; dan 0,019, secara berurutan). Tidak ada perbedaan tren yang ditemukan antarkelompok pada seri pertama parameter DTF, ΔTIV, ΔEELI-G, ΔEELI-ROI dan PaCO2 (p=0,951; 0,100; 0,935; 0,446; dan 0,705, secara berurutan) maupun pada seri kedua (p=0,556; 0,091; 0,429; 0,423; dan 0,687, secara berurutan). Tren PaO2 pada seri pertama dan kedua berbeda sangat signifikan (p<0,001) karena protokol pengaturan fraksi oksigen yang lebih tinggi pada kelompok TOK. Penggunaan HFNC tidak lebih baik daripada TOK dalam membantu mempertahankan fungsi diafragma pascapembedahan abdomen atas.

Upper abdominal surgery is related to diaphragmatic dysfunction. Diaphragmatic dysfunction is the main factors causing postoperative pulmonary complication (PPC). Conventional oxygen therapy (TOK) in the form of nasal cannula, is a standard therapy in post upper abdominal surgery patients. High-flow nasal cannula (HFNC) therapy has a variety of mechanisms that differ from TOK and is thought to be able to maintain diaphragm function in post upper abdominal surgery patients. This study aims to compare the ability of HFNC vs TOK in maintaining diaphragm function for post upper abdominal surgery patients. This study was conducted at RSUPN dr. Cipto Mangunkusumo from November 2018 - September 2019. Seventy-one patients were randomly divided into two groups: TOK and HFNC groups. Sixty-six patients received intervention after extubation in the intensive care unit (ICU). This given data were all collected periodically in 2 series; diaphragm thickening fraction (DTF) values using ultrasonography, changes in tidal impedance variance (ΔTIV), changes in global end expiratory lung impedance and region of interest (ΔEELI-G and ΔEELI-ROI) using electrical impedance tomography, arterial oxygen and carbon dioxide partial pressure (PaO2 and PaCO2). Side effects and complaints that arise were collected and managed. A total of 66 subjects were included in the bivariate using t-test and mann whitney test, while trends were analyzed by general linear models or generalized estimating equations. The baseline characteristics of mechanical ventilation duration in the ICU, the predicted mortality rate and P-POSSUM score between the two groups were significantly different (p = 0.003; 0.001; and 0.019, respectively). No trend differences were found between groups in the first series of DTF, ΔTIV, ΔEELI-G, ΔEELI-ROI and PaCO2 parameters (p = 0.951; 0.100; 0.935; 0.446; and 0.705, respectively) and in the second series (p = 0.556, 0.091, 0.429, 0.423 and 0.687, respectively). The PaO2 trends in the first and second series differed very significantly (p<0.001) due to the higher oxygen fraction regulation protocol in the COT group. The use of HFNC is no better than COT in maintaining diaphragm function for post upper abdominal surgery patients.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Tugas Akhir  Universitas Indonesia Library