Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang: Pasien pascabedah abdomen mayor seringkali berhubungan dengan terjadinya general increase permeability sindrom akibat kelebihan cairan selama selama durante operasi dan pada saat perawatan pascabedah. Tujuan dari penelitian ini adalah ingin membuktikan apakah keseimbangan cairan kumulatif, tekanan vena sentral dan rasio albumin-kreatinin urin dapat digunakan sebagai prediktor kebocoran kapiler. Metode: Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian adalah pasien dewasa yang menjalani tindakan bedah abdomen mayor. Dilakukan pemeriksaan keseimbangan cairan kumulatif, tekanan vena sentral, rasio albumin-kreatinin urin dan indeks kebocoran kapiler, pada saat sebelum induksi anestesi, 48 jam dan 72 jam pasca bedah. Hasil: Pada penelitian ini didapatkan nilai titik potong dari indeks kebocoran kapiler 155 (AUC 0,013, sensitifitas 100% dan spesifisitas 74,50%. Analisis dengan Generalized Estimating Equations didapatkan tekanan vena sentral menujukan hubungan tidak bermakna dengan indeks kebocoran kapiler (OR 1,62 ; CI 95% = 0,92 – 2,83), sedangkan keseimbangan cairan kumulatif dan rasio albumin kreatinin urin menunjukkan hubungan yang bermakna dengan indeks kebocoran kapiler (OR = 2,561 ; CI 95% = 1,352-4,850 dan OR = 2,017 ; CI 95% = 1,086-3,749). Faktor skor SOFA terkategori sepsis juga mempunyai hubungan dengan indeks kebocoran kapiler (OR = 2,764 ; CI 95% = 1,244-6,140). Kesimpulan: Kelebihan cairan kumulatif, rasio albumin kreatinin urin dan skor SOFA terbukti dapat digunakan untuk memprediksi kebocoran kapiler.

---

Background: Patients after major abdominal surgery are often associated with the occurrence of general increase in permeability syndrome due to excess fluid during surgery and during postoperative care. The purpose of this study was to prove whether cumulative fluid balance, central venous pressure and urine albumin-creatinine ratio of urine can be used as predictors of capillary leakage. Method: This study is a prospective cohort study with research subjects as adult patients undergoing major abdominal surgery. Cumulative fluid balance, central venous pressure, urine albumin-creatinine ratio and capillary leak index were examined, before anesthesia induction, 48 hours and 72 hours postoperatively. Result: In this study, a cut-off point from the capillary leak index ≥155 (AUC 0.013, sensitivity 100% and specificity 74.50%) was obtained. Generalized Estimating Equations analysis showed that the central venous pressure showed no significant relationship with the capillary leak index (OR 1.62; 95% CI = 0.92 - 2.83), while cumulative fluid balance and urine albumin : creatinin ratio showed a significant association with capillary leak index (OR = 2.561; 95% CI = 1.352-4.850 and OR = 2.017; 95% CI = 1,086-3,749) Sepsis categorized SOFA score factors also have a relationship with capillary leak index (OR = 2.764; 95% CI = 1,244-6,140). Conclusion: Cumulative fluid overload, urine creatinine albumin ratio and SOFA score have been shown to predict capillary leakage.

Abstrak :
ABSTRAK Nyeri pasca bedah abdomen adalah gabungan dari beberapa pengalaman sensori, emosional, dan mental yang tidak menyenangkan akibat trauma bedah. Walaupun nyeri telah dikelola dengan baik, kira-kira 86% pasien mengalami nyeri sedang ke hebat pasca bedah meskipun analgesik ditingkatkan. Penelitian ini bertujuan mendeskripsikan karakteristik responden (exploratory study) dan selanjutnya menjelaskan faktor-faktor yang mempengaruhi intensitas nyeri pasca bedah abdomen (explanatory study). Desain penelitian ini adalah deskriptif analitik dengan pendekatan cross sectional pada 67 orang responden pasca bedah abdomen. Pada penelitian ini digunakan instrumen State Anxiety Inventory (S-AI) Form Y untuk menilai keadaan cemas pasien pasca bedah abdomen, sikap dan keyakinan terhadap nyeri, dan skala nyeri untuk menilai intensitas nyeri pasca bedah menggunakan kombinasi Visual Analog Scale (VAS) dan Numeric Rating Scale (NRS). Hasil penelitian ini menunjukan bahwa faktor-faktor yang mempengaruhi secara signifikan terhadap intensitas nyeri pasca bedah abdomen adalah jenis kelamin (p value = 0,005), letak insisi (p value = 0,0005), dan tingkat kecemasan (p value = 0,0005). Faktor yang paling mempengaruhi intensitas nyeri pasca bedah abdomen adalah tingkat kecemasan (standardized coefficient β 0,501). Hasil penelitian ini bermanfaat bagi praktisi keperawatan sebagai acuan asuhan keperawatan dalam melakukan pengelolaan nyeri pasca bedah abdomen untuk mempertimbangkan faktor tingkat kecemasan, jenis kelamin, dan letak insisi. Rekomendasi hasil penelitian ini perlu adanya penelitian lebih lanjut dengan jumlah sampel yang lebih besar dan faktor-faktor lain yang dapat mempengaruhi nyeri.

---

ABSTRACT Abdominal postoperative pain is a combined of several unpleasant sensory, emotional, and mental experience precipitated by the surgical trauma. Pain experience are influenced by many factors and it is difficult to understand and about 86% of patients experience moderate to severe pain following surgery in the hospital. The purpose of this study was to identify the characteristic of respondent (exploratory study) and to explain influencing factors of abdominal postoperative pain intensity (explanatory study). The design was an analytic description using a cross sectional for 67 respondents abdominal postoperative. In the study using State Anxiety Inventory (S-AI) Form Y instrument was used to measure the abdominal postoperative state anxiety, attitudes and beliefs about pain, and pain scale using a combined Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) was used to measure postoperative pain intensity. The finding showed that gender (p value = 0,005), incision site (p value = 0,0005), and anxiety levels (p value = 0,0005) were significantly influencing factors of abdominal postoperative pain intensity. The most influencing factor of abdominal postoperative pain intensity was anxiety levels (standardized coefficient β 0,501). This study information for nursing practitioner as reference in nursing care planning should be considered anxiety levels, gender, and incision site to management of patients with postoperative pain relief. It is recommended to conduct further research using more samples and other factors that also may alter pain reaction.

Abstrak :
Kista duktus koledokus merupakan penyakit yang jarang terjadi, penyebabnya bisa kongenital ataupun didapat, berupa dilatasi kistik dari traktus bilier atau intrahepatik. Trias gejala klinis tampak: nyeri perut, jaundice, dan adanya massa di perut. Sekitar 20-30% semua gejala klinis tersebut bisa muncul. Di Indonesia sendiri, data epidemiologi mengenai kista duktus koledokus dan atresia bilier masih belum banyak dilaporkan. Namun, pada studi yang dilakukan di Rumah Sakit Cipto Mangunkusumo, atresia bilier merupakan penyebab kolestasis obstruktif tersering (>90%). Berdasarkan hasil studi tersebut, terdapat 60 pasien dengan atresia bilier yang berobat ke Departemen Ilmu kesehatan Anak RS Cipto Mangunkusumo dalam 12 tahun terakhir (tahun 1998-2009). Dan dari total pasien tersebut, hanya 20% pasien yang berobat pada usia kurang dari 2 bulan. Penatalaksanaan yang dilakukan adalah pembedahan laparatomi. Nyeri merupakan masalah keperawatan utama yang umumnya dikeluhkan oleh anak-anak post laparatomi. Nyeri yang tidak diatasi dengan baik akan mengakibatkan gangguan psikologis maupun secara fisik yang dapat menyebabkan trauma pada anak. Penatalaksanaan nyeri yang dilakukan pada An. M dengan pemberian posisi semi fowler untuk mengurangi tegangan pada insisi dan organ abdomen yang membantu mengurangi nyeri serta meningkatkan rasa kontrol anak dalam mengatasi nyeri. Pemberian posisi semi fowler efektif dalam mengurangi keluhan nyeri pada An. M, menurunkan skala nyeri dari 5 menjadi 2 dalam 3 hari. ......Choledochal duct cyst is a rare disease, the cause can be congenital or acquired, in the form of cystic dilatation of the biliary tract or intrahepatic. The triad of clinical symptoms appears: abdominal pain, jaundice, and a mass in the abdomen. About 20-30% of all these clinical symtoms can appear. In Indonesia alone, epidemiological data regarding common bile duct cysts and biliary atresia are still not widely reported. However, in a study conducted at Cipto Mangunkusumo Hospital, biliary atresia was the most common cause of obstructive cholestasis (>90%). Based on the results of the study, there were 60 patients with biliary atresia who went to the Department of Pediatrics at Cipto Mangunkusumo Hospital in the last 12 years (1998-2009). And of the total patients, only 20% of patients who seek treatment at the age of less than 2 months. The treatment is laparotomy. Pain is a major nursing problem that is generally complained of by post-laparotomy children.Pain that is not handled properly will result in psychological and physical disturbances that can cause trauma to children. Pain management performed on An. M by giving the semi fowler position to reduce tension on the inciosion and abdominal organs which helps reduce pain and increases the child’s sense of control in dealing with pain. Giving a semo fowler’s position is effective in reducing pain complaints in An. M, reduced pain scale from 5 to 2 in 3 days.

Abstrak :
Radiology of the post surgical abdomen provides a comprehensive overview of all abdominal operations involving the gastrointestinal tract, pancreas, hepatobiliary and genitourinary systems. Each chapter is fully illustrated with artists' drawings and radiological images of normal post operative anatomy. The complications associated with each procedure are described alongside imaging examples. Written by experts in the field, Radiology of the post surgical abdomen provides the reader with key teaching points emphasising differentiation between normal post-operative anatomy and complications.

Abstrak :
Latar Belakang: Infeksi daerah operasi (IDO) merupakan salah satu komplikasi pascaoperasi tersering yang meningkatkan morbiditas, mortalitas, dan beban biaya kesehatan. Penerapan strategi pencegahan hanya menurunkan sedikit angka infeksi nosokomial pada pembedahan. Vitamin D diketahui memiliki pengaruh pada regulasi imun dan penyembuhan luka. Namun, hanya sedikit studi yang menilai efek potensialnya dalam mengurangi kejadian IDO dengan hasil yang didapatkan belum konsisten. Penelitian ini bertujuan untuk menilai hubungan status vitamin D serum praoperasi dengan kejadian IDO pascalaparotomi elektif. Metode: Studi kohort prospektif ini dilakukan pada subjek berusia 18–65 tahun di RS pendidikan tersier, RSUPN Dr. Cipto Mangungkusumo, yang dirawat untuk laparotomi elektif pada bulan Maret hingga Juni 2023. Pengukuran 25-hidroksi vitamin D serum praoperasi menggunakan metode chemiluminescent microparticle immunoassay (CMIA) dengan cutoff defisiensi pada kadar <30 ng/mL. Penegakkan diagnosis IDO berdasarkan kriteria Centers for Disease Control and Prevention dilakukan melalui pemantauan harian selama 30 hari pascaoperasi. Analisis bivariat dan multivariat digunakan untuk menilai hubungan antara variabel bebas dan terikat, serta mengidentifikasi faktor perancu lain yang berhubungan dengan IDO.  Hasil: Dari total 117 subjek penelitian, sebanyak 90,4% subjek defisiensi vitamin D dan 20,5% subjek mengalami IDO. Defisiensi vitamin D praoperasi signifikan meningkatkan risiko kejadian IDO dibandingkan tidak defisiensi (RR 1,16, 95% CI 1,07–1,26). Analisis lanjutan dengan regresi logistik untuk faktor perancu lain memeroleh bahwa status albumin serum praoperasi menjadi faktor yang paling signifikan meningkatkan risiko kejadian IDO. Kesimpulan: Terdapat hubungan yang bermakna secara statistik antara defisiensi vitamin D serum praoperasi dengan kejadian IDO pascalaparotomi elektif. ......Background: Surgical site infection (SSI) is one of the most common postoperative complications that increases morbidity, mortality, and healthcare costs. The implementation of preventive strategies has only resulted in a slight reduction in nosocomial infection rates in surgical procedures. Vitamin D is known to have an influence on immune regulation and wound healing. However, there have been few studies assessing its potential effect in reducing the incidence of SSI, and the results obtained so far have been inconsistent. This study aims to assess the relationship between preoperative serum vitamin D status and the occurrence of SSI after elective laparotomy. Methods: This prospective cohort study was conducted on subjects aged 18–65 years at a single tertiary teaching hospital, RSUPN Dr. Cipto Mangunkusumo, who underwent elective laparotomy from March to June 2023. Measurement of preoperative serum 25-hydroxy vitamin D was done using the chemiluminescent microparticle immunoassay (CMIA) method with a deficiency cutoff at levels <30 ng/mL. The diagnosis of SSI was based on the Centers for Disease Control and Prevention criteria through daily monitoring for 30 days postoperatively. Bivariate and multivariate analyses were used to assess the relationship between independent and dependent variables and identify other confounding factors associated with SSI.  Results: Out of a total of 117 study subjects, 90.4% were vitamin D deficient, and 20.5% developed SSI. Preoperative vitamin D deficiency significantly increased the risk of SSI compared to non-deficiency (RR 1.16, 95% CI 1.07–1.26). Further analysis using logistic regression for other confounding factors revealed that preoperative serum albumin status was the most significant factor in increasing the risk of SSI. Conclusion: There is a significant statistical association between preoperative serum vitamin D deficiency and the occurrence of SSI after elective laparotomy.

Abstrak :
Latar Belakang: Ileus pascaoperasi (IPO) terjadi pada 3 – 32% pascaoperasi abdomen mayor. Prevalensi IPO di RSUPN dr. Cipto Mangunkusumo (RSCM) sendiri belum diketahui. Imbang cairan perioperatif berkontribusi terhadap kejadian IPO. Berbagai studi menunjukkan imbang cairan intra- dan pascaoperasi yang positif berhubungan dengan peningkatan risiko IPO, namun peran status hidrasi praoperasi belum diketahui. Pemeriksaan bioelectrical impedance vector analysis (BIVA) mulai digunakan untuk evaluasi status hidrasi, namun metode ini belum umum digunakan untuk evaluasi cairan perioperasi. Penelitian ini dilakukan untuk mengetahui insidensi IPO di RSCM, serta mengetahui hubungan antara IPO dengan status hidrasi praoperasi berdasarkan BIVA. Metode: Penelitian ini adalah studi potong lintang pada pasien yang menjalani laparotomi elektif di RSCM, Jakarta. Diambil karakteristik praoperasi berupa data demografis, antropometri, dan status hidrasi yang meliputi BIVA, osmolalitas serum, imbang cairan, dan rasio blood urea nitrogen/creatinine (rasio BUN/Cr); karakteristik intraoperasi yaitu imbang cairan intraoperasi, lama operasi, dan jumlah perdarahan; serta status hidrasi pascaoperasi yang dinilai pada hari kedua pascaoperasi. Dilakukan analisis hubungan IPO dengan status hidrasi praoperasi berdasarkan BIVA, yang dilanjutkan dengan analisis multivariat untuk menyingkirkan faktor perancu. Hasil: Sebanyak 90 subjek menjalani laparotomi elektif untuk kasus digestif (37,8%), ginekologi (57,8%), urologi (2,2%), serta join digestif-vaskular dan digestif- ginekologi (2,2%). Status hiperhidrasi praoperasi berdasarkan BIVA didapatkan sebanyak 38,9% dan meningkat menjadi 74,4% pascaoperasi. Osmolalitas serum pra- dan pascaoperasi berada dalam rentang normal dan tidak menunjukkan perubahan yang bermakna, sedangkan imbang cairan dan rasio BUN/Cr meningkat bermakna pascaoperasi. Status hiperhidrasi praoperasi berhubungan bermakna dengan IPO (OR 3.386, 95%CI 1.319 – 8.601; p=0.009). Namun berdasarkan analisis multivariat, hanya jumlah perdarahan intraoperasi (> 500 mL) yang berhubungan dengan IPO (OR 7.95, 95% CI 1.41 – 44.78; p=0.019). Stratifikasi lebih lanjut menunjukkan status hiperhidrasi praoperasi meningkatkan risiko IPO pada subjek dengan jumlah perdarahan intraoperasi kurang dari 500 mL (OR 6.8, 95% CI 1.436 – 32.197; p =0.016). Kesimpulan: Status hidrasi praoperasi menentukan keluaran klinis pascaoperasi. Status hiperhidrasi praoperasi berdasarkan BIVA ditemukan berhubungan dengan peningkatan risiko IPO laparotomi, namun status hiperhidrasi praoperasi dapat dimodifikasi oleh jumlah perdarahan intraoperasi. Dibutuhkan studi lebih lanjut hubungan antara IPO dengan status hiperhidrasi praoperasi, terutama pada kelompok subjek dengan jumlah perdarahan intraoperasi kurang dari 500 mL. ......Background: Postoperative ileus (POI) is a complication commonly found after major abdominal surgery, with a prevalence of 3 – 32%. Prevalence of POI at dr. Cipto Mangunkusumo Hospital (RSCM) is yet to be reported. Perioperative hydration status contributes to the risk of developing POI. Studies have shown that positive intra- and postoperative fluid balance are associated with increased risk of POI, but the role of preoperative hydration status is not yet known. Bioelectrical impedance vector analysis (BIVA) has started to be used widely to evaluate hydration status, nonetheless it is still not commonly used in evaluation of perioperative hydration status. This study aims to determine POI incidence in RSCM, and to explore the association between IPO and preoperative hydration status evaluated with BIVA. Methods: This study was a cross-sectional study done at RSCM, Jakarta. We recruited patients who were scheduled to undergo elective laparotomy. Preoperative characteristics were collected such as demographical data, anthropometry, and hydration status including BIVA, serum osmolality, fluid balance, and blood urea nitrogen/creatinine (BUN/Cr) ratio; intraoperative characteristics such as fluid balance, length of surgery, and total bleeding volume; and postoperative hydration status which was analyzed in postoperative day two. Analysis to determine the associatiob between POI and preoperative hydration status by BIVA was done, and continued with logistic regression analysis to control confounding factors. Results: Ninety subjects recruited in this study underwent elective laparotomy for digestive (37,8%), gynecology (57,8%), urology (2,2%), also joined digestive-vascular and digestive-gynecology (2,2%) surgery. Preoperative hyperhydration by BIVA was found in 38,9% subjects, and increased to 74,4% postoperatively. Pre- and postoperative serum osmolality were within normal range and did not show any significant increment, while fluid balance and BUN/Cr ratio increased postoperatively. Preoperative hyperhydration was associated with POI (OR 3.386, 95%CI 1.319 – 8.601; p=0.009). Only total bleeding volume (> 500 mL) was found to increase the risk of POI after logistic regression analysis (OR 7.95, 95% CI 1.41 – 44.78; p=0.019). Further stratification analysis showed that preoperative hyperhydration increased the risk of POI in subjects with total bleeding less than 500 mL (OR 6.8, 95% CI 1.436 – 32.197; p =0.016). Conclusion: Preoperative hydration status has an impact on postoperative clinical outcome. Preoperative hyperhydration was found to increase the risk of POI, but preoperative hyperhydration status could be modified by the degree of intraoperative bleeding. Further study needs to be done to determine the link between POI and preoperative hyperhydration, especially in subjects with total bleeding less than 500 mL.

Abstrak :
Pembedahan laparatomi merupakan salah satu modalitas penatalaksanaan pada pasien dengan carcinoma recti. Penggunaan agen anestesi pada pasien yang menjalani prosedur bedah laparatomi dapat menyebabkan timbulnya gangguan aktivitas peristaltik usus. Penerapan terapi mobilisasi dini pada pasien post operasi laparatomi bertujuan untuk mempercepat timbulnya aktivitas peristaltik usus sehingga mencegah terjadinya komplikasi seperti infeksi nosokomial dan lambatnya proses penyembuhan luka bedah. Penerapan terapi mobilisasi dini yang dilakukan setiap 2 jam sekali selama 6 hari perawatan terbukti mampu mempercepat timbulnya aktivitas peristaltik usus yang ditunjukkan dengan timbulnya bising usus dengan frekuensi 6-8x/menit serta berkurangnya keluhan mual dan begah yang dialami pasien, hingga keluhan tersebut hilang pada hari ketiga sejak dilakukan mobilisasi dini. Hasil penerapan mobilisasi dini pada pasien post operasi laparatomi ini dapat dijadikan sumber informasi perawat dalam melakukan keperawatan mandiri dalam mengurangi mual dan begah seiring munculnya aktivitas peristaltik usus, serta mengurangi nyeri dan mempercepat proses penyembuhan. ...... Laparatomy surgery is one of the management modalities in patients with carcinoma recti. The use of anesthetic agents in patients undergoing laparotomy surgical procedures can cause disruption of intestinal peristaltic activity. The application of early mobilization therapy to post laparotomy patients aims to accelerate the emergence of intestinal peristaltic activity so as to prevent complications such as nosocomial infections and the slow healing process of surgical wounds. The application of early mobilization therapy that is carried out every 2 hours for 6 days of treatment is proven to be able to accelerate the occurrence of intestinal peristaltic activity as indicated by the emergence of bowel sounds with a frequency of 6-8x / minute and reduced complaints of nausea and pain experienced by patients, until the complaint disappears on the day third since early mobilization. The results of the application of early mobilization in postoperative laparotomy patients can be used as a source of information for nurses in carrying out independent nursing in reducing nausea and sickness as intestinal peristaltic activity arises, as well as reducing pain and accelerating the healing process.

Abstrak :
This is the first time a book about laparoscopy in emergency abdominal surgery has been published. Numerous articles have been published in specific surgical journals, but, until now, there has not been a book that collates all the aspects of this little-known field. The aim of this volume is to achieve a complete and easy presentation of all the implications associated with laparoscopy in emergency abdominal surgery. The book should be a manual that can be easily consulted by digestive, general, and specialized surgeons, especially in an emergency. The authors’ contributions are founded on evidence-based medicine, which give the book scientific credibility, but this is coupled with their experience of daily practice, which adds an important complementary dimension to evidence-based medicine. This is balanced by an emphasis on clarity and accessibility, because the ultimate aim of the book is educational.