Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKLatar Belakang. Efek penurunan kadar hematokrit oleh manitol memberimanfaat lebih pada tata laksana cedera kepala. Kadar hematokrit 30-35%merupakan kadar hematokrit efektif untuk mendapatkan keluaran yang baik pascacedera kepala. Meski dosis awal rekomendasi pemberian manitol memilikirentang yang cukup besar antara dosis rendah dengan dosis tingginya, kedua dosisini memiliki efektivitas yang sama dalam menurunkan Tekanan Intrakranial(TIK). Diduga kedua dosis ini juga memiliki efek yang sama terhadap penurunankadar hematokrit.Metode. Penelitian ini merupakan uji eksperimental klinis dengan randomizedcontrolled trial tersamarkan. Subjek penelitian adalah pasien cedera kepalasedang (CKS) dan cedera kepala berat (CKB) dengan gejala dan tanda klinispeningkatan TIK yang terindikasi mendapat terapi manitol yang datang ke RumahSakit Cipto Mangunkusumo (RSCM) Jakarta dan bersedia mengikuti penelitian.Dilakukan wawancara, pemeriksaan fisik umum dan neurologis serta pemeriksaankadar hematokrit. Dilakukan analisis data menggunakan perangkat SPSS 17.0.Hasil. Diperoleh 30 subjek pasien cedera kepala sedang dan berat yang mendapatterapi manitol, masing-masing 15 orang untuk kelompok manitol dosis 0.5g /kgBB dan 1g/ kgBB. Terjadi penurunan kadar hematokrit sebesar 5% padakelompok dosis 0.5g/ kgBB dan sebesar 6% pada kelompok manitol dosis 1g/kgBB pasca 10 menit pemberian manitol. Kadar tersebut meningkat kembali kekadar normal 6 jam pasca pemberian. Didapatkan kecendrungan penurunan ratarataMean Arterial Blood Pressure (MABP) dan frekuensi nadi pasca 10 menitpemberian manitol, yang kemudian mengalami peningkatan nilai saat dilakukanpengukuran 6 pasca jam pemberian. Didapatkan kecendrungan peningkatan GCSdan perbaikan reaktivitas pupil pada kedua kelompok dosis manitol di dua waktupengukuran.Kesimpulan. Terdapat kecenderungan penurunan kadar hematokrit pasca 10menit pemberian manitol, yang meningkat kembali ke kadar normal 6 jam pascapemberian pada kedua dosis manitol yang diteliti. Pada penelitian ini jugadidapatkan kecendrungan perbaikan kondisi klinis pasien yang tidak berbeda padakedua dosis manitol pasca 10 menit dan 6 jam pemberian.

---

ABSTRACTBackground: The decreasing effect of hematocrit due to mannitol givesadditional benefit in management of traumatic brain injury (TBI). Hematocritlevel of 30 - 35% is the effective level to obtain good outcome after TBI. Eventhough initial recommended dosage of mannitol has a relatively wide rangebetween low and high dosage, both dosages have similar effectivity in reducingintracranial pressure (ICP). It is assumed that both dosages also have similareffect on decreasing hematocrit level.Methods: This was a clinical experimental study with double-blind randomizedcontrolled trial. The study subjects were patients with moderate and severe TBIwith signs and symptoms of increased ICP who have indications to be givenmannitol and were hospitalized in Cipto Mangunkusumo Hospital, Jakarta andagree to participate in the study. All subjects were interviewed, underwent generaland neurological physical examination, as well as level of hematocrit. Dataanalysis were done by using SPSS 17.0.Results: There were 30 patients with moderate and severe TBI who receivedmannitol. They were divided into two groups, each consists of 15 patients. Thefirst group received mannitol 0.5g/kgBW and the second group received 1g/kgBW. Hematocrit level was decreased by 5% in the first group, and 6% in thesecond group after 10 minutes administration of mannitol. The hematocrit levelwas observed to increase to its normal value after 6 hours administration ofmannitol. There was a tendency of decreasing Mean Arterial Blood Pressure(MABP) and heart rate after 10 minutes administration of mannitol, which thenwould increased after 6 hours after administration. In addition, there were alsotendencies of increasing GCS and better pupillary reactivity in both groups onboth measurement.Conclusions: The hematocrit level was found to decrease after 10 minutesadministration of mannitol, and increase back to its normal value after 6 hoursadministration on both dosages. This study also found that moderate and severeTBI patients receiving mannitol tend to show clinical improvement which weresimilar on both dosages both after 10 minutes and 6 hours of adminstration."

"ABSTRAKLatar Belakang: Pasien cedera kepala sedang (CKS) dan cedera kepala berat (CKB) memerlukan perawatan di rumah sakit sehingga beresiko terkena infeksi nosokomial seperti pneumonia yang dapat memperburuk keluaran. Karena banyaknya faktor yang dapat mempengaruhi keluaran pasien cedera kepala dengan pneumonia, diperlukan suatu sistem skoring untuk menilai derajat keparahan pneumonia.Tujuan: Untuk mengetahui apakah sistem skoring CURB-65 dapat dipakai untuk memprediksi keluaran pasien CKS dan CKB yang mengalami pneumonia.Metode: Penelitian ini merupakan studi prospektif. Subjek penelitian adalah seluruh pasien CKS dan CKB yang dirawat di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta selama periode penelitian. Diagnosis pneumonia ditegakkan sesuai kriteria The Center for Disease Control (CDC). Penilaian derajat keparahan pneumonia dilakukan dengan skoring CURB-65. Keluaran yang dinilai adalah hidup atau meninggal.Hasil: Dari 176 pasien CKS dan CKB, terdapat 26 pasien yang menderita pneumonia. Rentang usia subjek penelitian adalah 15 - 71 tahun. Sebagian besar berjenis kelamin laki-laki dan berusia < 65 tahun. Nilai maksimal dari CURB-65 pada penelitian ini adalah 3. Sedangkan nilai yang terbanyak adalah 2. Nilai CURB-65 ditemukan tidak bermakna sebagai prediktor keluaran pasca cedera kepala. Keluaran pasien cenderung dipengaruhi variabel usia, penurunan kesadaran, peningkatan kadar BUN, dan peningkatan frekuensi napas. Diantara 5 pasien yang meninggal, ada 2 pasien yang memiliki nilai CURB-65 = 3, sehingga tampak adanya kecenderungan peningkatan mortalitas pada pasien-pasien dengan nilai CURB-65 = 3.Kesimpulan: Walaupun skoring CURB-65 tidak bermakna sebagai prediktor keluaran pada pasien CKS dan CKB dengan pneumonia, penelitian pendahuluan ini menemukan adanya kecenderungan pengaruh masing-masing komponen CURB-65 (penurunan kesadaran, frekuensi napas, kadar BUN, serta usia) terhadap resiko kematian pasien

---

ABSTRACTBackground: Patients with moderate and severe traumatic brain injury (TBI) require hospitalization, therefore they have higher risk in developing nosocomial infections such as pneumonia which can worsen their outcomes. Since there are many factors that can affect outcome of head-injured patients with pneumonia, a scoring system for evaluating the severity of pneumonia is needed.Objective: To know whether the CURB-65 scoring system can be used to predict the outcome of moderate and severe TBI patients who developed pneumonia during hospitalization.Methods: This was a prospective study. The study subjects were all moderate and severe TBI patients who had been hospitalized in Cipto Mangunkusumo Hospital during the research period. Diagnosis of pneumonia was confirmed if the patient fulfiled the criteria from The Center for Disease Control (CDC). The severity of pneumonia was determined by using CURB-65 scoring system. The outcome would either be dead or alive.Results: Of 176 patients with moderate and severe TBI, there were 26 patients who developed pneumonia. The age of the subjects ranged between 15 to 71 years. Most of them were male and over the age of 65. The maximum score of CURB-65 was 3. The mode of CURB-65 score was 2. CURB-65 was shown to be not useful in predicting outcome of head-injured patients with pneumonia. The outcome was seemingly associated with age, loss of consciousness, BUN, and respiratory rate. Among 5 patients who were dead, there were 2 patients who had a CURB-65 score of 3, thus there was a trend of increasing mortality in patients with a CURB-65 score of 3.Conclusions: Although the CURB-65 scoring system was not found to be useful in predicting outcome of moderate and severe TBI patients, this preliminary study have found that there were a tendency that each component of CURB-65 (loss of consciousness, respiratory rate, BUN, age) have some effects on mortality. "