Tesis

Efektivitas Pemberian Deksametason dalam Memengaruhi Durasi Perawatan di Rumah Sakit Pada Operasi Bedah Pintas Arteri Koroner Off Pump = Effectiveness of Dexamethasone Administration in Affect Lenght of Hospital Stay in Off Pump Coronary Artery Bypass Graft Surgery.

Latar Belakang: Teknik bedah pintas arteri koroner (BPAK) off pump diharapkan mampu menghilangkan efek samping dan komplikasi yang ditimbulkan akibat penggunaan mesin pintas jantung paru (PJP). Namun teknik ini tidak sepenuhnya bebas dari efek samping atau komplikasi. Salah satu efek yang dapat ditimbulkan adalah peningkatan respons inflamasi sistemik, sehingga durasi rawat menjadi lebih lama. Hal tersebut menjadi dasar penelitian ini untuk melakukan studi pemberian deksametason dalam memengaruhi durasi rawat inap pada pasien yang menjalani operasi BPAK off pump. Metode: Penelitian ini merupakan studi observasional analitik dengan enam puluh pasien yang menjalani operasi BPAK off-pump dan dibagi dalam kelompok deksametason atau plasebo masing-masing 30 orang. Hasil klinis dianalisis. Hasil: Lama rawat inap kelompok deksametason berbeda bermakna dibandingkan kelompok plasebo berturut-turut 5 (5-8) hari vs 6,5 (5-30) hari; p=0,04). Keluaran klinis lain pada kelompok deksametason lebih baik daripada kelompok plasebo, dalam hal durasi ventilasi mekanis (p=0,03) dan perawatan di unit perawatan intensif (p=0,03). Terdapat perbedaan penanda inflamasi yang signifikan antara kedua kelompok: interleukin-6 (p=0,0001), prokalsitonin (p=0,0001), dan C-reaktif protein (p=0,0001) lebih rendah pada kelompok deksametason. Kesimpulan: Deksametason praoperasi pada pasien yang menjalani operasi BPAK off pump efektif dalam mengurangi lama rawat pasien di rumah sakit dan mengendalikan reaksi inflamasi pascaoperasi.
Kata kunci: Antiinflamasi, pintas arteri koroner, off pump, deksametason


Background: The off pump coronary artery bypass surgery (OPCAB) technique is expected to be able to eliminate the side effects and complications caused by the use of a cardiopulmonary bypass (CPB) machine. However, this technique is not completely free from side effects or complications. One of the effects that can be caused is an increase in the systemic inflammatory response, so that the duration of hospitalization becomes longer. This is aim of this study to conduct a study of the administration of dexamethasone for reduced the length of hospital stay in patients undergoing OPCAB surgery. Methods: This was an analytic observational study with sixty patients who underwent OPCAB surgery and were randomized to either dexamethasone or placebo groups of 30 people each. Clinical results were analyzed. Results: The length of stay in the dexamethasone group compared to the placebo group was consecutive (5 (5-8) days vs 6.5 (5-30) days; p=0.04) so that there was a significant difference. Other clinical outcomes in the dexamethasone group were better than the placebo group, in terms of duration of mechanical ventilation (p=0.03) and intensive care unit stay (p=0.03). There were significant differences in inflammatory markers between the two groups: interleukin-6 (p=0.0001), procalcitonin (p=0.0001), and C-reactive protein (p=0.0001) were lower in the dexamethasone group. Conclusion: Preoperative dexamethasone in patients undergoing off-pump coronary artery bypass is effective in reducing the length of hospital stay and controlling postoperative inflammatory reactions.
Keywords: Anti-inflammatory, coronary artery bypass, off-pump, dexamethasone.