Hasil guna formula bebas laktosa pada tatalaksana diare akut rotavirus di Rumah Sakit Sanglah Denpasar

HARTAWAN, I Nyoman Budi, Prof. dr. Srisuparyati Soenarto, Ph.D, Sp.A(K)

2008 | Tesis | S2 Ilmu Kedokteran Klinik

Diare akut rotavirus menyebabkan kerusakan mukosa, penumpulan vili, pemendekan vili dan kematian sel. Proses ini mengakibatkan sekresi enzim laktase menurun sehingga terjadi gangguan penyerapan laktosa. Laktosa yang tidak terserap menyebabkan diare osmotik menyertai diare sekretorik sehingga memperlambat penyembuhan diare. Pemberian formula bebas laktosa dapat mengurangi laktosa dalam lumen usus, sehingga dapat memperpendek lama diare. Tujuan penelitian adalah membandingkan hasil guna antara formula bebas laktosa dan susu formula untuk tatalaksana nutrisi diare akut rotavirus. Penelitian ini adalah uji klinis acak terkontrol tersamar ganda pada bayi dan anak berusia ≥ 6 - ≤ 59 bulan di Divisi Gastroenterologi Anak, yang menderita diare akut rotavirus dehidrasi ringan sedang. Rotavirus dideteksi dengan latex agglutination test. Setelah terehidrasi maka subyek mendapat formula bebas laktosa (n = 30) atau susu formula (n = 30). Luaran berupa perbandingan lama diare, peningkatan berat badan, frekuensi buang air besar dan waktu yang diperlukan agar tinja menjadi kental. Analisis statistik yang digunakan untuk membandingkan kedua kelompok adalah student t-test. Rerata lama diare di rumah sakit pada kelompok formula bebas laktosa yaitu 57,59 jam (SD 9,40) dan susu formula 85,97 jam (SD 13,94) dengan beda rerata 28,38 jam (SE 3,09) (IK 95% 22,19;34,56, p = 0,001). Frekuensi buang air besar dan waktu yang diperlukan agar tinja menjadi kental berbeda signifikan namun tidak pada peningkatan berat badan. Pada analisis multivariat (Cox Regression) didapatkan hanya perlakuan yang secara bermakna berpengaruh terhadap lama diare. Penelitian membuktikan bahwa formula bebas laktosa dapat memperpendek lama diare akut rotavirus.

Acute rotavirus diarrhea causes mucosa destruction, blunted villi, shortening villi, and cell death. The process also decreases lactose enzyme secretion which responsible in lactose absorption. Non absorbed lactose then causes the progression of osmotic diarrhea along with secretory diarrhea and cause delayed recovery. Lactose-free formula can decrease lactose, so that the duration of diarrhea episode can be shortened. The objective of this study was to compare the outcome between lactose-free formula and dairy milk formula in the managemant of acute rotavirus diarrhea. A randomized, double-blind clinical trial of infant and children aged ≥ 6 to 59 months, admitted to Divisions of Pediatric Gastroenterology with acute rotavirus diarrhea and mild or moderate dehydration was carried out. Latex agglutination test was used to detect rotavirus. After appropriate rehydration, they were fed either a lactose-free formula (n = 29) or dairy milk formula (n = 30). Comparisons of duration of diarrhea, weight gain, and stool frequency were made. Statistical analysis for compare the two groups is student t-test. The mean duration of diarrhea in lactosefree formula group was 57,59 hours (SD 9,40) and dairy milk formula 85,97 hours (SD 13,94), mean difference 28,38 hours (SE 3,09) (95% CI 22,19;34,56, p = 0,001). Significantly decrease in stool frequency were seen in the lactose-free formula group, but were not the weight gain. Multivariate analysis (Cox regression) revealed only the intervention was affected significanly. Lactose-free formula can shortened the duration of acute rotavirus diarrhea.

Kata Kunci : Diare akut rotavirus,Formula bebas laktosa,Susu formula,Uji klinis acak terkontrol tersamar ganda,Acute rotavirus diarrhea,lactose-free formula,dairy milk,randomized,double-blind clinical trial