KADAR GLUKOSA DARAH SEBAGAI FAKTOR RISIKO KEPARAHAN CEDERA KEPALA

NOER RAKHMAWATI, dr. Indarwati Setyaningsih, Sp.S(K)

2013 | Tesis | S2 Kedokteran Klinik

Latar Belakang. Cedera kepala merupakan penyebab utama kematian dan kecacatan di dunia. Data di Amerika Serikat tahun 2009 menurut Centers for Disease Control and Prevention didapatkan cedera kepala ringan sampai berat sebesar 1,7 juta, sebanyak lebih dari 1,4 juta dirawat di unit gawat darurat dan 52.000 meninggal setiap tahunnya dikarenakan cedera kepala Cedera kepala banyak terjadi pada orang muda dan menjadi penyebab kematian 15 – 20 % pada usia 5 - 35 th. Penelitian mengenai kadar glukosa darah sebagai faktor risiko keparahan cedera kepala di Indonesia belum banyak dilakukan. Penelitian ini bertujuan untuk mengetahui kadar glukosa darah sebagai faktor risiko keparahan cedera kepala. Metode. Penelitian ini menggunakan rancangan potong lintang. Pengambilan sampel dilakukan secara berurutan (concecutive sampling) serta disesuaikan dengan kriteria inklusi maupun eksklusi penelitian. Masing-masing subjek diminta menandatangani surat persetujuan (informed consent) ikut penelitian. Penelitian dilakukan saat pasien masuk RSUP Dr. Sardjito dan RSUP Soeradji Tirtonegoro Klaten selama pasien mendapat perawatan baik di bangsal intermediate care maupun bangsal Saraf. Analisis statistik untuk masing-masing variabel adalah dengan x2 test untuk data parametrik dan Fisher test untuk data non parametrik. Hasil analisis univariat dilanjutkan dengan analisis multivariate menggunakan analisis regresi logistic dengan metode backward stepwise. Hasil . Jumlah sampel yang didapat pada penelitian ini adalah 87 pasien. Didapatkan kejadian peningkatan kadar glukosa darah (hiperglikemia) sebanyak 26 pasien. Onset terjadinya peningkatan kadar glukosa darah dalam 24 jam pertama terjadi pada 6 pasien pada dengan tingkat kesadaran ringan dan 6 pasien dengan tingkat kesadaran sedang-berat. Variabel dari analisis univariat yang memenuhi syarat untuk analisis multivariat adalah hiperglikemi (RP 4,778, 95% CI 1.292-17,669; p=0,019), respirasi (RP 5,327, 95% CI 1,218-23,905; p=0,026), dan reaksi pupil (RP 27,866, 95% CI 4,313-180,037; p<0,001) yang bermakna terhadap keparahan cedera kepala. Kesimpulan. Kadar glukosa darah merupakan faktor risiko independen terhadap keparahan cedera kepala.

Background. Head injury is the leading cause of death and disability in the world. The data in the United States in 2009 according to the Centers for Disease Control and Prevention found mild to severe head injury at 1.7 million, a total of more than 1.4 million were treated in emergency rooms and 52,000 die each year because of head injuries, the survivors will have disability and affects the emotional, social and economic exposure to patients and their families. Head injuries are common in young people and the cause of death of 15-20% at the age of 5-35 years old. Research on blood glucose levels as risk factors for the severity of head injuries in Indonesia has not been much done. This study aims to determine the blood glucose level as risk factors for the severity of head injuries. Method. This study used a nested case-control design. Sampling has done in a concecutive after it adapted to inclusion or exclusion criteria. Each subject was asked to sign informed consent. The study was conducted on admission to the hospital Dr. Sardjito and all patient were receiving treatment for both stroke. Statistical analysis for each variable is using x2 test for parametric and Fisher test for non-parametric data.The results of univariate analysis followed by multivariate analysis with logistic regression. Result. The number of samples obtained in this study were 87 patients. Achieved increased incidence of blood glucose levels (hyperglycemia) as many as 26 patients. The onset of the increase in blood glucose levels within the first 24 hours occurred in 6 patients at the mild level of consciousness and 6 patients with moderate to severe levels of consciousness. Variables from the univariate analysis were eligible for multivariate analysis were hyperglycemia (RP 4.778, 95% CI 1292 to 17.669, p = 0.019), respiration (RP 5.327, 95% CI 1.218 to 23.905, p = 0.026), and the reaction of the pupil (RP 27.866, 95% CI 4.313 to 180.037, p <0.001) were significant to the severity of head injuries. Conclusion. Blood glucose levels are an independent risk factor for severity of head injury.

Kata Kunci : Kadar Glukosa, Faktor Risiko, Tingkat Keparahan, Cedera Kepala