Efek asam hyaluronat pada penyembuhan luka pasca seksio sesarea di RSUP DR. Sardjito

PRIYAMBODO, Bambang, dr. Rukmono S., M.Kes.,SpOG(K)

2010 | Tesis |

Latar Belakang: Morbiditas maternal sehubungan dengan adanya infeksi luka operasi meningkat delapan kali dibandingkan persalinan vaginal. Laporan kasus adanya infeksi luka seksiosesarea bervariatif dari 0,3% di Turkey, 11,6% di Brasil, 18,3% di Saudi Arabia.Sediaan asam hyaluronat yang diberikan secara topikal dapat mempercepat penyembuhan luka baru, luka ulkus dan dapat untuk luka kronis. Tujuan: Mengetahui keefektifan asam hyaluronat dalam mengurangi infeksi luka operasi bedah sesarea. Desain: Penelitian dilakukan secara eksperimental dengan uji klinik secara random (randomized control trial) dengan penyamaran ganda (double blind). Metode :Subyek penelitian adalah semua pasien yang menjalani operasi seksiosesarea di RSUP.Dr Sardjito yang memenuhi kriteria inklusi dan ekslusi, menandatangani surat persetujuan tindakan kemudian dilakukan randomisasi blok antara yang mendapat asam hyaluronat dan yang mendapat plasebo. Dilakukan penilaian infeksi dengan skor ASEPSIS (‘Additional treatment, Serous discharge, Erythema, Purulent exudates, Separation of deep tissue, Isolation of bacteria, Stay as inpatient prolonged over 14 days’).Luka dikatakan terinfeksi jika skor yang didapat lebih dari 20. Pengamatan dilakukan saat ganti perban, kontrol minggu pertama, kontrol satu bulan pasca operasi dan kontrol tiga bulan pasca operasi. Hasil: Sebanyak 8 orang dari 60 orang responden pada penelitian ini antara yang mendapat asam hyaluronat dan yang mendapat plasebo angka kejadian infeksi sama besarnya yaitu masing-masing 4 kejadian infeksi.Total kejadian infeksi pasca seksiosesarea sebesar 8 infeksi dari 60 seksiosesarea (13,3%), sehingga pemberian asam hyaluronat pada luka pasca seksiosesarea tidak bermakna mengurangi kejadian infeksi (p>0,05). Dari hasil kultur yang ada, paling banyak disebabkan karena coagulase-negative Staphylococci sebanyak 3 pasien (42,9%), dua karena infeksi Pseudomonas aeruginosa (28,6 %), yang lainnya masing-masing 1(14,3%) oleh Klebsiella oxytosa, 1(14,3%) Staphylococcus alfa, dan1(14,3%) karena Escherichia coli. Kesimpulan :Pemberian asam hyaluronat tidak bermakna mengurangi kejadian infeksi pasca seksiosesarea.

Background: Maternal Morbidity in relation to the presence of postoperative infection increased eight times compared with vaginal delivery.Report cases of postoperative wound infections cesarean section varied from 0.3% in Turkey, 11.6% in Brazil, 18.3% in Saudi ArabiaHyaluronic acid preparations given topically can speed healing of new wounds, ulcers and wounds to chronic wounds. Objective: To determine the effectiveness of hyaluronic acid in reducing cesarean section wound infection. Design: experimental study was conducted with randomized control trial with double blind Methods: Subjects were all patients who underwent cesarean section at this hospital who meet inclusion and exclusion criteria, signed a letter of approval from the action and then conducted a randomized block between the hyaluronic acid and a placebo.Assessment of infection with a score ASEPSIS ('Additional treatment, serous discharge, erythema, Purulent exudates, Separation of deep tissues, Isolation of bacteria, Stay as inpatient prolonged over 14 days'). Wound is said to be infected if the score obtained more than 20.Observations were carried out when changing dressings, control of the first week, one month post-operative control and control three months after operation Results: As many as eight people from 60 respondents in this study between hyaluronic acid and received a placebo, the incidence of infection as much of each of four incidents of infection. The total incidence of postoperative infection for cesarean section 8 of infection from 60 cesarean section (13.3%), thus providing hyaluronic acid on postoperative wound cesarean section did not significantly reduce the incidence of infection (p> 0.05).From the results of the existing culture, most often caused by coagulase-negative Staphylococci were three patients (42.9%), two because of infection Pseudomonasaeruginosa (28.6%), the others each 1 (14.3%) by Klebsiella oxytosa, 1 (14.3%) Staphylococcus alpha, and1 (14.3%) due to Escherichia coli. Conclusion: application of hyaluronic acid did not significantly reduce the incidence of post cesarean section surgical site infection.

Kata Kunci : Asam hyaluronat,SSI (Surgical site infection),Asepsis