Perbedaan nilai maksimum dan minimum protein plasma, hematokrit dan trombosit terhadap awal kejadian syok penderita demam berdarah dengue di Instalasi kesehatan anak RS Dr. Sardjito

NURHAYATI, Desiana, Prof.dr. Tonny Sadjimin, MPH.,MSc.,PhD.,Sp.A(K)

2004 | Tesis | PPDSI Ilmu Kesehatan Anak

Latar Belakang. Patofisiologi penting Demam Berdarah Dengue (DBD) adalah kebocoran plasma yang dimanifestasikan oleh peningkatan hematokrit (hemokonsentrasi), efusi serosa atau hipoproteinemia. Level hematokrit berhubungan erat dengan kehilangan volume plasma dan beratnya penyakit. Kebocoran plasma dapat mengakibatkan syok, anoksia dan kematian. Tujuan. Penelitian ini bertujuan untuk menetapkan perbedaan nilai maksimum dan minimum protein plasma, hematokrit dan trombosit terhadap awal kejadian syok penderita DBD. Metoda. Anak terdiagnosis DBD (kriteria WHO sesuai ICDX A91.X, R57.8) yang menjalani rawat inap di INSKA RS Dr. Sardjito Januari 2002-Agustus 2003. Derajat penyakit sesuai derajat DBD kriteria WHO. Spesimen darah didapatkan dari pengukuran saat masuk dan secara serial sesuai kebutuhan (berdasar standar prosedur laboratorium RS Dr. Sardjito). Nilai plasma protein, hematokrit dan trombosit tercantum di dalam monitor tertutup. Persentase kenaikan hematokrit, penurunan protein plasma dan penurunan trombosit dihitung. Dicari hubungan, nilai hematokrit, kenaikan hematokrit, nilai protein plasma, penurunan protein plasma, nilai trombosit dan penurunan trombosit terhadap awal kejadian syok dengan analisis regresi logistik bivariat dan multivariat. Hasil. Didapatkan subyek yang memenuhi kriteria inklusi dan eksklusi. Persentase kenaikan hematokrit maksimum terhadap saat recovery adalah sebesar 24,36%. Persentase penurunan protein plasma minimum terhadap saat recovery adalah 14,79%. Persentase penurunan trombosit minimum terhadap saat recovery 235,37%. Pada analisis bivariat nilai hematokrit dan persentase kenaikan hematokrit maksimum terhadap saat recovery secara statistik bermakna berhubungan dengan awal kejadian syok (OR:1,12; IK 95%:1,05-1,19; p=0,001), demikian pula pada analisis multivariat (OR: 1,12; IK 95%: 1,04-1,21; p=0,004). Nilai protein plasma, penurunan protein plasma, nilai trombosit dan penurunan trombosit tidak bermakna secara statistik berhubungan dengan awal kejadian syok. Simpulan. Persentase kenaikan hematokrit maksimum terhadap saat recovery adalah sebesar 24,36%, penurunan protein plasma minimum terhadap saat recovery adalah 14,79%. Persentase penurunan trombosit minimum terhadap saat recovery 235,37%. Persentase kenaikan hematokrit maksimum terhadap saat recovery berhubungan dengan awal kejadian syok. Tidak ada hubungan nilai protein plasma, persentase penurunan protein plasma dan trombosit terhadap awal kejadian syok.

Background. The important pathophysiology of Dengue Hemorrhagic Fever (DHF) is plasma leakage which is manifested by the increasing of hematocrit (hemoconcentration), serous effusion or hypoproteinaemic. Hematocrit level closely relates to the loss of plasma volume and disease severity. Plasma leakage can generate shock, anoxia and death. Objective. The objective of this study is to determine the difference of maximum and minimum value for plasma protein, hematocrit and thrombocyte with the early incidence of shock. Method. Children who were confirmed as DHF according WHO criteria (ICDX A91.X, R57.8) and hospitalized in Department of Child Health Dr. Sardjito Hospital during January 2002-August 2003 were enrolled to the study. The severity of DHF cases based on the grading of WHO criteria. Blood specimen was taken from at the first coming and subsequently (based on standard procedure in Dr. Sardjito Hospital laboratory). The value of plasma protein, hematocrit and thrombocyte listed on the closed monitor. Percentage of increasing hematocrit, decreasing of plasma protein and decreasing of thrombocyte value were computed. The correlation of increasing hematocrit, decreasing of plasma protein, decreasing of thrombocyte, hematocrit, plasma protein and thrombocyte value to the early incidence of shock were analized using the bivariate and multivariate logistic regression. Result. All of patients fulfill the inclusive and exclusive criteria were admitted to this study. The difference of hematocrit between the maximum level and recovery phase is 24,36%. There is decreasing of plasma protein between the minimum level and recovery phase (14,79%). The difference of thrombocyte between the minimum level and recovery phase is 235,37%. It is shown by bivariate analysis that the value of hematocrit and the difference of increasing hematocrit at the maximum level and recovery phase is statistically significant (OR:1.12; 95% CI:1.05-1.19; p=0.001) with the early incidence of shock, whether by multivariate analysis (OR:1,12; 95% CI: 1.04-1,21; p=0.004). Percentage of decreasing plasma protein, decreasing of thrombocyte, plasma protein and thrombocyte value statistically not significant correlated with the early incidence of shock. Conclusion. The difference of hematocrit between the maximum level and recovery phase is 24,36%, decreasing of plasma protein between the minimum level and recovery phase is 14,79%, decreasing of thrombocyte between the minimum level and recovery phase is 235,37%. The difference of increasing hematocrit at the maximum level and recovery phase correlated with the early incidence of shock. There is no correlation in percentage of decreasing plasma protein and thrombocyte value to the early incidence of shock

Kata Kunci : Demam Berdarah Dengue,Syok,Hematokrit, Protein Plasma, Trombosit, Dengue Hemorrhagic Fever-plasma protein-hematocrit-thrombocyteshock