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ABSTRAKLatar Belakang. Efek penurunan kadar hematokrit oleh manitol memberi
manfaat lebih pada tata laksana cedera kepala. Kadar hematokrit 30-35%
merupakan kadar hematokrit efektif untuk mendapatkan keluaran yang baik pasca
cedera kepala. Meski dosis awal rekomendasi pemberian manitol memiliki
rentang yang cukup besar antara dosis rendah dengan dosis tingginya, kedua dosis
ini memiliki efektivitas yang sama dalam menurunkan Tekanan Intrakranial
(TIK). Diduga kedua dosis ini juga memiliki efek yang sama terhadap penurunan
kadar hematokrit.
Metode. Penelitian ini merupakan uji eksperimental klinis dengan randomized
controlled trial tersamarkan. Subjek penelitian adalah pasien cedera kepala
sedang (CKS) dan cedera kepala berat (CKB) dengan gejala dan tanda klinis
peningkatan TIK yang terindikasi mendapat terapi manitol yang datang ke Rumah
Sakit Cipto Mangunkusumo (RSCM) Jakarta dan bersedia mengikuti penelitian.
Dilakukan wawancara, pemeriksaan fisik umum dan neurologis serta pemeriksaan
kadar hematokrit. Dilakukan analisis data menggunakan perangkat SPSS 17.0.
Hasil. Diperoleh 30 subjek pasien cedera kepala sedang dan berat yang mendapat
terapi manitol, masing-masing 15 orang untuk kelompok manitol dosis 0.5g /
kgBB dan 1g/ kgBB. Terjadi penurunan kadar hematokrit sebesar 5% pada
kelompok dosis 0.5g/ kgBB dan sebesar 6% pada kelompok manitol dosis 1g/
kgBB pasca 10 menit pemberian manitol. Kadar tersebut meningkat kembali ke
kadar normal 6 jam pasca pemberian. Didapatkan kecendrungan penurunan ratarata
Mean Arterial Blood Pressure (MABP) dan frekuensi nadi pasca 10 menit
pemberian manitol, yang kemudian mengalami peningkatan nilai saat dilakukan
pengukuran 6 pasca jam pemberian. Didapatkan kecendrungan peningkatan GCS
dan perbaikan reaktivitas pupil pada kedua kelompok dosis manitol di dua waktu
pengukuran.
Kesimpulan. Terdapat kecenderungan penurunan kadar hematokrit pasca 10
menit pemberian manitol, yang meningkat kembali ke kadar normal 6 jam pasca
pemberian pada kedua dosis manitol yang diteliti. Pada penelitian ini juga
didapatkan kecendrungan perbaikan kondisi klinis pasien yang tidak berbeda pada
kedua dosis manitol pasca 10 menit dan 6 jam pemberian.
ABSTRACTBackground: The decreasing effect of hematocrit due to mannitol gives
additional benefit in management of traumatic brain injury (TBI). Hematocrit
level of 30 - 35% is the effective level to obtain good outcome after TBI. Even
though initial recommended dosage of mannitol has a relatively wide range
between low and high dosage, both dosages have similar effectivity in reducing
intracranial pressure (ICP). It is assumed that both dosages also have similar
effect on decreasing hematocrit level.
Methods: This was a clinical experimental study with double-blind randomized
controlled trial. The study subjects were patients with moderate and severe TBI
with signs and symptoms of increased ICP who have indications to be given
mannitol and were hospitalized in Cipto Mangunkusumo Hospital, Jakarta and
agree to participate in the study. All subjects were interviewed, underwent general
and neurological physical examination, as well as level of hematocrit. Data
analysis were done by using SPSS 17.0.
Results: There were 30 patients with moderate and severe TBI who received
mannitol. They were divided into two groups, each consists of 15 patients. The
first group received mannitol 0.5g/kgBW and the second group received 1g/
kgBW. Hematocrit level was decreased by 5% in the first group, and 6% in the
second group after 10 minutes administration of mannitol. The hematocrit level
was observed to increase to its normal value after 6 hours administration of
mannitol. There was a tendency of decreasing Mean Arterial Blood Pressure
(MABP) and heart rate after 10 minutes administration of mannitol, which then
would increased after 6 hours after administration. In addition, there were also
tendencies of increasing GCS and better pupillary reactivity in both groups on
both measurement.
Conclusions: The hematocrit level was found to decrease after 10 minutes
administration of mannitol, and increase back to its normal value after 6 hours
administration on both dosages. This study also found that moderate and severe
TBI patients receiving mannitol tend to show clinical improvement which were
similar on both dosages both after 10 minutes and 6 hours of adminstration."
