Tesis

Terapi Medik Gizi Pada Pasien Luka Bakar Derajat Berat: Kajian Kecukupan Protein Terhadap Imbang Nitrogen = Medical Nutritional Therapy in Severe Burns Patients: Study of Protein Adequacy For Nitrogen Balance.

Latar Belakang: Pada luka bakar terjadi hiperkatabolisme berupa degradasi protein otot sebagai respon stres. Selain itu terjadi juga kehilangan protein melalui kulit yang rusak dan peningkatan permeabilitas pembuluh darah. Pemberian tinggi protein merupakan bagian penting dalam mengatasi dampak buruk dari hiperkatabolisme serta penyediaan substrat untuk penyembuhan luka pada pasien. Salah satu cara untuk menilai kecukupan protein pada pasien adalah dengan mengukur imbang nitrogen. Metode: Serial kasus ini terdiri dari 4 pasien luka bakar karena ledakan gas dan api yang dirawat di ULB RSCM dari periode Agustus hingga November 2022. Terapi medik gizi yang diberikan ditingkatkan bertahap sesuai toleransi dan kondisi klinis pasien hingga mencapai kebutuhan energi total berdasarkan formula Xie, dengan target protein 1,5–2 g /kgBB/hari. Keempat pasien serial kasus dilakukan pemeriksaan imbang nitrogen pada minggu pertama dan pada saat asupan protein mencapai 1,5 g/kgBB/hari. Hasil: Pada keempat pasien serial kasus didapatkan imbang nitrogen negatif dengan rentang negatif 4,1 –13,68 g saat pemeriksaan awal di minggu pertama, dan pada pemeriksaan kedua saat asupan protein mencapai 1,5 g/kgBB/hari didapatkan imbang nitrogen antara negatif 1,8–17,46 g. Kesimpulan: Pada serial kasus ini hanya 1 pasien yang memiliki imbang nitrogen ekuilibrium sementara ketiga pasien lainnya memiliki imbang protein negatif saat asupan protein mencapai 1,5 g/kgBB/hari.
Kata kunci: luka bakar, hiperkatabolisme, protein, imbang nitrogen.



Background: Hypercatabolism in the form of muscle protein degradation occurs in burns as a stress response. There is also protein loss through damaged skin and increased vascular permeability. Giving high protein is an important part of overcoming the adverse effects of hypercatabolism and providing substrates for wound healing in patients. Measuring nitrogen balance is one way to assess protein adequacy in patients. Methods: This case series consisted of 4 patients with burns due to a gas explosion and fire who were admitted to ULB RSCM from August to November 2022. Nutritional medical therapy given was gradually increased according to patient tolerance and clinical condition until it reached total energy requirements based on the Xie formula, with a protein target of 1.5–2 g/kgBB/day. The four case series patients were examined for nitrogen balance in the first week and when their protein intake had reached 1.5 g/kg/day. Results: In all four case series patients, negative nitrogen balance was obtained with a range of negative 4.1 –13.68 g at the initial examination in the first week, and in the second examination when protein intake had reached 1.5 g/kgBW/day, the nitrogen balance was between negative 1.8–17.46 g. Conclusion: In this case series only 1 patient had an equilibrium nitrogen balance while the other three patients had a negative protein balance when protein intake had reached 1.5 g/kg/day.
Keywords: burns, hypercatabolism, protein, nitrogen balance.