Hubungan rehabilitasi pulmoner dengan sesak nafas (Jarak tempuh jalan 6 menit) pada penderita penyakit paru obstruktif kronik

WULAN, Heni Retno, Prof.dr. Tonny Sadjimin, MPH.,MSc.,PhD.,SpAK

2004 | Tesis | S2 Ilmu Kedokteran Klinis

Peringkat penyebab kematian karena PPOK di dunia cenderung meningkat. Morbiditas dan keterbatasan aktivitas fisik yang berat karena PPOK mencapai jumlah yang seimbang. Terdapat 402.800 penderita PPOK di Indonesia. Obstruksi saluran nafas, peningkatan ventilasi dan emfisema menyebabkan kelelahan otot respirasi. Kelelahan otot respirasi menyebabkan sesak nafas. Sesak nafas menyebabkan gangguan fungsi kualitas hidup. Rehabiltiasi pulmoner bertujuan menstabilkan kedua fungsi fisio dan psikopatologi. Penelitian ini bertujuan (1), mengetahui efek rehabilitasi pulmoner terhadap nilai sesak nafas : jarak yang ditempuh oleh penderita jalan cepat selama 6 menit dibanding penderita dibanding penderita PPOK yang tidak mendapat rehabiltiasi pulmoner, (2), mengetahui efek rehabilitasi pulmoner terhadap kualitas hidup penderita PPOK sebesar 7,1 poin skor the St. George Repiratory Questionnaire dibanding penderita yang tidak mendapat rehabiltasi. Di RS. Dr. Sardjito. Rancangan penelitian ini adalah kohort prospektif dengan subyek sebanyak 177 penderita PPOK. Delapan puluh tujuh di antaranya mengikuti rehabilitasi. Didapatkan hasil (1), median beda jarak tempuh jalan 6 menit sebesar 41 meter (p<0,001), (2), median beda skor Borg Scale sebesar 1 poin skor (p<0,001) dan (3) beda rerata skor total SGRQ sebesar 8,76 poin skor (p<0,001). Variabel yang berpengaruh terhadap jarak tempuh jalan 6 menit yaitu frekuensi rehabilitasi dan pekerjaan swasta sebesar R2 0,36. Didapatkan RR 3,21 (95% CI 1,69-6,08) untuk mnecapai perubahan jarak tempuh jalan 6 menit pada penderita PPOK yang menjalani rehabilitasi dibanding penderita PPOK yang tidak menjalani reabilitasi. Variabel yang berpengaruh terhadap skor Borg Scale adalah frekuensi rehabilitasi dan jenis kelamin sebesar R2 0,20. Variabel yang berpengaruh terhadap skor SGRQ adalah frekuensi rehabilitasi sebesar R2 0,25. Didapatkan RR 9,46 (95% CI 4,59-19,52) untuk mencapai perubahan skor total SGRQ sebesar 7,1 poin skor pada penderita yang menjalani rehabilitasi dibanding penderita yang tidak menjalani rehabilitasi.

Mortality rate caused by COPD in the world tends to increase. Morbidity and limitation of heavy physical activity cause by COPD reach the equilibrium amount.The prevalence of COPD patients in Indonesia 402,800. Obstruction of the respiratory tract, increase of ventilatio, and emphysema lead to weakening of respiratory muscle cause dyspneu which impairs the quality of life. The gool of pulmonary rehabilitation is to stabilize both physiology and psychopathology functions. The aims of this research are (1), to investigate the pulmonary rehabilitation on dyspneu ( a fast 6-minutes walk) on rehabilitated COPD patients compared to non rehabilitated COPD patients is 37,9 meter, (2), to ascertain that the difference between the effect of pumonary rehabilitation on quality of life of rehabilitated COPD patients and non rehabilitated COPD patient is 7.1 poin score the St. George Respiratory Questionnaire. The study design of the research is porspective cohort. One hundred and seventy seven COPD patients joined the pulmonary rehabiltation programe. The result of this research are, (1), the difference between the median of 6-minute walk of rehabilitated patients and non rehabilitated COPD patients is 41 meter, (2), the difference between the median of poin score of Borg Scale of rehabilitated patients and non rehabilitated COPD patients is 1 poin score, (3), the difference between the mean of total poin score of the St. George Respiratory questionnaire of rehabilitated patients and non rehabilitated COPD patients is 8.76 poin score. Variable which may affect the result of a 6-minute walk test are frequency of rehabilitation and jobs (1.36 R square). Variable which may affect the result of a 6-minute walk test are frequency of rehabilitation and jobs (1.36 R square). To achieve 37.9 meter a-6 walk test changes on rehabilitated COPD patient compare non rehabilitated COPD RR 3.21 (95% CI 1.69-6.08). Variable which may affect the result of Borg Scale are frequency of rehabilitation and sex (1.36 R square). Variable which may affect the result of a 6-minute walk test are frequency of rehabilitation and jobs (1.36 R square). To achieve 7.1 poin score the St. George Respiratory Questionnaire changes on rehabilitated COPD patient compare non rehabilitated COPD RR 9.46 (95% CI 4.59-19.52).

Kata Kunci : Epidemiologi Klinik,Penyakit Paru Obstruktif Kronik,Sesak Nafas,Rehabilitasi Pulmoner