Tesis

Perbandingan Tata Laksana Cairan Pada Pre-Eklamsia Antara Pemberian Koloid 1 mL/kgBB/jam dan Furosemide 5 mg/jam dengan Kristaloid 80 mL/jam: Perubahan Profil Hemodinamik dan Kadar Albumin dalam Plasma = Strategic Comparison of Fluid Management in Pre-Eclampsia before Sectio Caesarea between Colloid 1cc/kgBW/hr plus Furosemide 5mg/hr and Crystalloid 80cc/hr: Hemodynamic Optimalization and Plasma Albumin Level Improvements.

Latar Belakang: Pre-eklamsia di dunia berkontribusi sebagai penyebab mortalitas dan morbiditas utama pada ibu hamil, dan merupakan 7-10 % penyulit kehamilan. Selama ini secara global pemberian tata laksana cairan pada preeklamsia belum menggunakan protokol khusus, sehingga berpotensi terjadinya edema paru. Proses pergeseran cairan yang terjadi di interstitial dapat dinilai secara objektif dengan monitor non-invasif. Tujuan: Mengetahui efek pemberian koloid 1mL/kgBB dan furosemide 5mg/jam dibandingkan dengan kristaloid 80mL/jam sebagai terapi cairan pada pasien preeklamsia terkait profil hemodinamik dan kadar albumin dalam plasma. Metode: Uji acak klinis tersamar tunggal terhadap 40 pasien dibagi menjadi 2 kelompok, yang akan dilakukan tindakan operasi sectio caesarea dengan perlakuan pemberian cairan pre-operatif yang berbeda, yaitu pemberian cairan koloid HES 6% 1cc/kgBB/jam dengan furosemide 5 mg/jam dan pemberian kristaloid 80 mL/jam. Analisis statistik dengan menggunakan uji Mann-Whitney dan uji generalized estimating equations (GEE). Hasil: Penurunan kadar albumin pada grup F secara bermakna lebih rendah dibanding grup K (p=0,002). Uji GEE menunjukkan perbedaan yang bermakna antar kelompok antar waktu pengukuran pada MAP (p < 0,001; OR=0,301 [0,168-0,542]), TFC (p < 0,001; OR=0,230 [0,154-0,344]), FTc (p=0,009; OR=32,716 [2,405-445,066]), dan PVI (p=0,004; OR=0,601 [0,424-0,852]). Kesimpulan: Pemberian koloid 1mL/kgBB dan furosemide 5mg/jam mempengaruhi perbaikan parameter profil hemodinamik dan kadar albumin dalam plasma.
Kata kunci: pre-eklampsia, pemberian koloid, diuretik, kristaloid, profil hemodinamik, kadar albumin


Background: Pre-eclampsia in the world presents as a major cause of mortality and morbidity in pregnant women, and as many as 7-10% is complicating the pregnancy. The specific protocol for fluids administration in preeclampsia has not been used a globally, and potentially generating pulmonary edema. The process of fluid shifting that occurs in the interstitial can be assessed objectively with a non-invasive monitor. Objective: To determine the effect of colloid 1mL/kg and furosemide 5 mg/hour administration compared with crystalloid 80mL/hour administration as fluid therapy in preeclampsia patients related to hemodynamic profile and plasma albumin levels. Methods: Single blinded randomized clinical trials of 40 patients who met the criteria were divided into 2 groups and were given different pre-operative fluids. Group F received 1cc/kg/hour of HES 6% with 5 mg/hour of furosemide and group K received 80 mL/hour of crystalloid. Statistical analysis was performed by using Mann-Whitney test dan generalized estimating equations (GEE) test. Results: The reduction of albumin levels in group F was significantly lower than in group K (p=0,002). The GEE test showed significant difference between group in through different measurement time in MAP (p < 0,001; OR=0,301 [0,168-0,542]), TFC (p < 0,001; OR=0,230 [0,154-0,344]), FTc (p=0,009; OR=32,716 [2,405-445,066]), and PVI (p=0,004; OR=0,601 [0,424-0,852]). Conclusion: Colloid and furosemide administration affect improvements of hemodynamic profile parameters and plasma albumin levels in parturients with preeclampsia.
Keywords: pre-eclampsia, colloid administration, diuretic, crystalloid, hemodynamic profile, albumin level.