HUBUNGAN ANTARA LAMA CPB DAN AORTIC CROSS CLAMP DENGAN MORTALITAS DAN PEMANJANGAN LAMA RAWAT DI ICU PADA PASIEN PASCA OPERASI KATUP JANTUNG DI RSUP DR. SARDJITO

DIANA ANGGRAINI, DR.Med. Dr. Untung Widodo, Sp.An. KIC.; Dr. Bhirowo Yudo Pratomo, SpAn, KAKV

2017 | Tesis-Spesialis | SP ILMU ANESTESIOLOGI DAN REANIMASI

Latar Belakang: Penggunaan CPB pada operasi jantung akan mengakibatkan perubahan fisiologis yaitu: (i) perubahan pulsatilitas, pola aliran darah dan tekanan, (ii) paparan darah pada permukaan nonfisiologis dan kerusakan darah akibat tekanan (shear stress), (iii) hemodilusi, (iv) respon stress sistemik dan (v) derajat hipotermia (atau hipertermia selama rewarming), sedangkan AOX menyebabkan iskemia dan cedera reperfusi yang mengakibatkan cedera post iskemia di miosit, endotel koroner, dan mikrosirkulasi. Pemanjangan lama CPB dan AOX akan meningkatkan morbiditas dan mortalitas. Intensive care unit (ICU) merupakan perawatan standar setelah operasi jantung. Pemanjangan lama rawat di ICU mengakibatkan peningkatan mortalitas, morbiditas sehingga akan meningkatkan biaya dan sumber daya. Tujuan: Untuk mengetahui hubungan lama CPB dan AOX terhadap pemanjangan lama rawat dan mortalitas di ICU. Metode: Kohort retrospektif pada pasien pasca operasi katup jantung tahun 20102016 sebanyak 98 pasien, yang memenuhi kriteria inklusi 87, eksklusi 11, drop out 30 sehingga didapatkan 57 pasien pada luaran mortalitas, sedangkan pada luaran pemanjangan lama rawat di ICU kriteria eksklusi ditambah 6 pasien (meninggal di ICU <3 hari) sehingga didapatkan 51 sampel. Analisis menggunakan univariat, bivariat, dan multivariat. Hasil: Dari 51 pasien, 9 (15%) memiliki lama rawat di ICU > 3 hari, rerata lama CPB 119,2+32,5 menit, AOX 92,7+27,7 menit. Dari 57 pasien, 7 (12,3%) meninggal di ICU, rerata lama CPB 113,7+37,3 menit, AOX 79,3+36 menit. Analisis tidak menunjukkan pengaruh lama CPB dan AOX terhadap luaran, namun terdapat faktor CHF+lainnya (p=0,019 OR 7,7 CI 95% 1,39-42,66) yang mempengaruhi pemanjangan lama rawat di ICU, sedangkan mortalitas meningkat pada setiap peningkatan satu angka skor APACHE II (p=0,015 OR 1,69 CI 95% 1,11-2,58). Kesimpulan: Tidak terdapat hubungan antara lama CPB dan AOX terhadap pemanjangan lama rawat dan mortalitas di ICU.

Background: Major physiologic trespasses introduced by CPB (cardiopulmonary bypass) are (i) alterations of pulsatility and blood flow patterns; (ii) exposure of blood to nonphysiologic surfaces and shear stresses; (iii) hemodilution, and (iv) exaggerated stress responses, while AOX (aortic cross clamp) causes ischemia and reperfusion injury, then causes injury post ischemia in myosit, coronary endotel, and microcirculation. Prolonged CPB and AOX time are associated with increased morbidity and mortality. Intensive care unit (ICU) after cardiac surgery is a standard component of treatment for patients. Prolonged stay in ICU usually results in increased hospital mortality, increased morbidity and consequently increased cost and expences. Objective: To determine CPB and AOX time have significant effect on postoperative prolonged stay and mortality in ICU. Methods: Retrospective kohort of 98 patients who underwent valvular heart surgery from January 2010 to December 2016. Among 98 patients, 87 patients were inclusion criteria, 11 patients were exclusion, so obtained 57 samples were analysis for mortality in ICU while 51 patients were analysis for prolonged stay in ICU (added 6 patients were included exclusion criteria). Univariate, bivariate, and multivariate analysis for risk factors were performed. Results: Among 51 patients, 9 (15%) had ICU stay > 3 days, the mean+SD CPB was 119,2+32,5 min, AOX 92,7+27,7 min. Among 57 patients, 7 (12,3%) had mortality in ICU, the mean+SD CPB was 113,7+37,3 min, AOX 79,3+36 min. Statistically showed that there is no correlation between duration of CPB and AOX with prolonged stay and mortality in ICU, but we found increased prolonged stay in patient with comorbid (CHF+other) (p=0,019 OR 7,7 CI 95% 1,39-42,66) while mortality increased in every increasing one value of APACHE II score (p=0,015 OR 1,69 CI 95% 1,11-2,58). Conclusion: There were no correlation of CPB and AOX time against prolonged stay and mortality in ICU.

Kata Kunci : Lama CPB, AOX, operasi katup jantung, pemanjangan lama rawat dan mortalitas di ICU, CPB time, AOX time, valvular heart surgery, prolonged stay and mortality in ICU