Tesis

Faktor-faktor Intraoperatif yang Memengaruhi Kejadian Stroke Iskemik Pascaoperasi Jantung dengan Mesin Pintas Jantung Paru = Intraoperative factors associated with ischemic stroke after cardiac surgery with cardiopulmonary bypass.

Latar belakang: Stroke iskemik merupakan salah satu komplikasi penting dan berdampak negatif pada operasi jantung yang menggunakan MPJP. Sejumlah faktor intraoperatif dianggap berpengaruh terhadap kejadian stroke iskemik yaitu mean arterial pressure (MAP), kecepatan rewarm, kadar glukosa darah, durasi bypass, durasi klem silang aorta, hemoglobin dan hematokrit. Metode: Penelitian ini merupakan studi analitik retrospektif dengan disain kasus-kontrol. Subjek dengan komplikasi stroke pascaoperasi jantung dengan MPJP selama periode januari 2016 sampai desember 2018 sebagai kelompok kasus dan pasien tanpa stroke iskemik pada periode yang sama sebagai kontrol. Analisis statistik dilakukan terhadap MAP, durasi bypass, durasi klem silang aorta, kadar glukosa darah, hematokrit dan hemoglobin pada kedua kelompok. Analisis statistik juga dilakukan terhadap faktor preoperatif yaitu usia, hipertensi, diabetes mellitus, jenis operasi dan perbandingan kelompok dengan durasi bypass diatas dan dibawah 120 menit. Hasil: Jenis kelamin, usia, diabetes melitus dan hipertensi tidak memiliki perbedaan yang bermakna antara kelompok kasus dan kontrol (p > 0,05). Hematokrit (p = 0,015, OR 0,939 [0,885-0,996]) dan durasi bypass (p = 0,027, OR 1,011 [1,001-1,021]) merupakan faktor intraoperatif yang berpengaruh terhadap kejadian stroke pascaoperasi. Prosedur operasi katup (p = 0,024, OR 3,127 [1,161-8,427]) dan aorta (p = 0,038, OR 3,398 [1,07010,786]) memiliki hubungan yang bermakna dengan kejadian stroke pascaoperasi. Analisis tambahan pada kelompok stroke dengan durasi bypass diatas dan dibawah 120 menit menunjukkan bahwa durasi bypass (p = 0,001) dan klem silang aorta (p = 0,017) memiliki perbedaan yang bermakna. Pada kelompok stroke dengan bypass diatas 120 menit, faktor durasi bypass prosedur aorta (p = 0,001) dan klem silang prosedur katup (p = 0,001) juga menunjukkan perbedaan yang bermakna. Simpulan:. Faktor intraoperatif yang memengaruhi kejadian stroke iskemik pascaoperasi jantung dewasa yang menggunakan MPJP di RSJPDHK adalah durasi bypass dan nilai hematokrit. Prosedur operasi aorta dan katup memiliki risiko lebih tinggi terhadap kejadian stroke dibandingkan prosedur operasi jantung lain.
Kata kunci: durasi bypass, hematokrit, operasi jantung, stroke iskemik


Introduction: Ischemic stroke is one of the important complications and has a negative impact on heart surgery using MPJP. A number of intraoperative factors are considered to affected the incidence of ischemic stroke, namely mean arterial pressure (MAP), rewarm speed, blood glucose level, bypass duration, duration of aortic cross clamps, hemoglobin and hematocrit. Method: This study is a retrospective analytic study with case-control design. Subjects with stroke complications following cardiac surgery with MPJP during the period January 2016 to December 2018 as a case group and patient without ischemic stroke in the same period as controls. Statistical analysis was performed on MAP, bypass duration, duration of aortic cross clamps, blood glucose levels, hematocrit and hemoglobin in both groups. Statistical analysis was also performed on preoperative factors, namely age, hypertension, diabetes mellitus, type of surgery and comparison of groups with duration of bypass above and below 120 minutes. Results: Gender, age, diabetes mellitus and hypertension did not have a significant difference between the case and control groups (p > 0.05). Hematocrit (p = 0.015, OR 0.939 [0.885-0.996]) and duration of bypass (p = 0.027, OR 1.011 [1,001-1,021]) is an intraoperative factor that influences the incidence of postoperative stroke. Valve surgery procedures (p = 0.024, OR 3.127 [1,161-8,427]) and aorta (p = 0.038, OR 3.398 [1,070-10,786]) had a significant association with postoperative stroke events. Additional analysis in the stroke group with bypass duration above and below 120 minutes showed that the bypass duration (p = 0.001) and aortic cross-clamping (p = 0.017) had significant differences. In the stroke group with overpass over 120 minutes, the duration of aortic procedure bypass (p = 0.001) and cross-clamping valve procedures (p = 0.001) also showed significant differences. Conclusion: Intraoperative factors that influence the incidence of postoperative cardiac ischemic stroke using MPJP in RSJPDHK are bypass duration and hematocrit value. Aortic and valve surgery procedures have a higher risk of stroke than other cardiac surgery procedures
Keywords : bypass duration, cardiac surgery, hematocrit, ischemic stroke