Tesis

Perbandingan antara Peak Systole Velocity, Volume Flow dan Tekanan Sistolik Arteri Poplitea dengan Derajat Ulkus Kaki Diabetik Berdasarkan Kriteria Wagner dan Keputusan Tindakan Debridemen atau Amputasi = Comparison of Peak Systole Velocity, Volume Flow and Systolic Pressure of the Popliteal Artery with the Degree of Diabetic Foot Ulcers Based on Wagner's Criteria and the Decision to Debridement or Amputation.

Latar Belakang. Ulkus kaki diabetik (UKD) akibat neuropati diabetes adalah komplikasi serius pada diabetes yang mengurangi sensasi pada kaki. Penelitian sebelumnya telah mengevaluasi berbagai parameter untuk memprediksi derajat luka, namun hasilnya masih beragam. Parameter seperti transkutaneus oksigen (TcPO2) menunjukkan hubungan yang signifikan, sedangkan parameter lain, seperti tekanan sistolik ibu jari kaki dan ankle, tidak menunjukkan hasil yang konsisten. Penelitian ini bertujuan mengevaluasi hubungan antara peak systolic velocity (PSV), volume flow (VF), dan tekanan darah sistolik (TDS) arteri poplitea terhadap derajat luka UKD berdasarkan klasifikasi Wagner. Metode. Penelitian observasional analitik dengan desain potong lintang ini dilakukan di RSUP Nasional Dr. Cipto Mangunkusumo Jakarta pada Juli– Desember 2024. Sampel adalah pasien UKD yang dipilih dengan consecutive sampling. Kriteria inklusi meliputi pasien UKD berusia 18–60 tahun, sedangkan eksklusi mencakup pasien dengan kondisi yang menghambat pemeriksaan. Variabel bebas adalah PSV, VF, dan TDS arteri poplitea, sementara variabel terikat adalah derajat luka berdasarkan klasifikasi Wagner. Data dianalisis menggunakan uji korelasi Spearman dan analisis regresi logistik. Hasil. Penelitian melibatkan 71 pasien (43 wanita, 28 pria) dengan rerata usia 59,96 ± 12,08 tahun. Sebagian besar pasien memiliki riwayat hipertensi (66,2%) dan dislipidemia (78,9%), serta tidak merokok (62%). Rerata PSV, VF, dan TDS berturut-turut adalah 59,82 ± 22,78 cm/detik, 42,25 ± 27,37 m³/detik, dan 153,89 ± 28,23 mmHg. Analisis korelasi menunjukkan hanya TDS yang berkorelasi signifikan dengan derajat luka Wagner (r = -0,285, p = 0,016), sementara PSV dan VF tidak signifikan secara statistik. Korelasi antara TDS dan keputusan debridemen atau amputasi juga signifikan (r = -0,250, p = 0,036), menunjukkan bahwa tekanan sistolik tinggi berkaitan dengan keputusan debridemen. Simpulan. Tekanan sistolik arteri poplitea memiliki korelasi signifikan terhadap derajat luka UKD berdasarkan klasifikasi Wagner dan keputusan debridemen atau amputasi. Parameter PSV dan VF tidak menunjukkan hubungan signifikan. Penelitian ini mendukung penggunaan TDS sebagai indikator objektif dalam menilai kondisi luka UKD dan menentukan keputusan terapi, meskipun diperlukan penelitian lebih lanjut untuk validasi.
Kata Kunci: ulkus kaki diabetik, klasifikasi Wagner, peak systolic velocity, volume flow, tekanan darah sistolik, debridemen, amputasi


Background: Diabetic foot ulcers (DRUs) due to diabetic neuropathy are a serious complication of diabetes that reduces sensation in the feet. Previous studies have evaluated various parameters to predict wound degree, but the results are mixed. Parameters such as transcutaneous oxygen (TcPO2) showed a significant association, while other parameters, such as toe and ankle systolic pressure, did not show consistent results. This study aimed to evaluate the relationship between peak systolic velocity (PSV), volume flow (VF), and systolic blood pressure (TDS) of the popliteal artery and the degree of UKD wound based on Wagner's classification. Methods: This analytic observational study with a cross-sectional design was conducted at Dr. Cipto Mangunkusumo National Hospital Jakarta in JulyDecember 2024. The sample was UKD patients selected by consecutive sampling. Inclusion criteria included UKD patients aged 18-60 years, while exclusion included patients with conditions that prevented examination. The independent variables were PSV, VF, and TDS of the popliteal artery, while the dependent variable was the degree of wound based on Wagner's classification. Data were analyzed using Spearman correlation test and logistic regression analysis. Results: The study included 71 patients (43 women, 28 men) with a mean age of 59.96 ± 12.08 years. Most patients had a history of hypertension (66.2%) and dyslipidemia (78.9%), and did not smoke (62%). The mean PSV, VF, and TDS were 59.82 ± 22.78 cm/sec, 42.25 ± 27.37 m³/sec, and 153.89 ± 28.23 mmHg, respectively. Correlation analysis showed that only TDS was significantly correlated with Wagner wound degree (r = -0.285, p = 0.016), while PSV and VF were not statistically significant. The correlation between TDS and debridement or amputation decision was also significant (r = -0.250, p = 0.036), suggesting that high systolic pressure is associated with debridement decision. Conclusion: Popliteal artery systolic pressure had a significant correlation with the degree of UKD wound based on Wagner classification and the decision of debridement or amputation. PSV and VF parameters showed no significant association. This study supports the use of TDS as an objective indicator in assessing UKD wound condition and making treatment decisions, although further research is needed for validation.
Keywords: diabetic foot ulcer, Wagner classification, peak systolic velocity, volume flow, systolic blood pressure, debridement, amputation