Skripsi

Disfungsi Saluran Cerna pada Anak Sakit Kritis: Tinjauan pada Gambaran Manifestasi Klinis Gastrointestinal dan Kadar Sitrulin Plasma = Gastrointestinal Dysfunction in Critically Ill Children: a Study of Clinical Gastrointestinal Manifestations and Plasma Citrulline Levels.

Latar Belakang Disfungsi saluran cerna relatif sering dijumpai pada pasien anak sakit kritis. Sitrulin plasma dinilai lebih akurat untuk menilai disfungsi saluran cerna, dengan nilai potong optimal ≤13,8 μmol/L. Penelitian ini bertujuan mendeskripsikan profil klinis disfungsi saluran cerna berdasarkan kadar sitrulin plasma pasien anak sakit kritis. Metode Dibutuhkan minimal 37 sampel pada penelitian potong lintang ini. Pasien dengan penyakit hati, ginjal, atau diabetes tidak diikutsertakan. Data yang dikumpulkan meliputi karakteristik dasar, kejadian disfungsi saluran cerna berdasarkan kadar sitrulin plasma, serta manifestasi klinis gastrointestinal (intoleransi nutrisi enteral, konstipasi (khusus konstipasi diambil dalam 48 jam pertama), distensi abdomen, diare, perdarahan saluran cerna, muntah, dan hilangnya bising usus) dalam 24 jam pertama perawatan intensif. Hasil Sebanyak 25 subjek penelitian dengan median usia 50 (17–140) bulan dan skor PELOD-2 3 (1–4) berhasil direkrut. Mayoritas adalah laki-laki, bergizi normal, pasca operasi, tidak hipoksemia, menderita anemia, dan tidak mendapat opioid maupun katekolamin. Prevalensi disfungsi saluran cerna mencapai 36%. Manifestasi klinis gastrointestinal pada saluran cerna meliputi intoleransi nutrisi enteral (32%), konstipasi (16%), distensi abdomen (16%), diare (20%), perdarahan saluran cerna (20%), muntah (12%), dan hilangnya bising usus (8%). Analisis inferensial untuk mengetahui hubungan manifestasi klinis gastrointestinal dengan kejadian disfungsi saluran cerna berdasarkan sitrulin tidak dapat dilakukan, sebab jumlah sampel yang tidak mencukupi. Kesimpulan Disfungsi saluran cerna pada pasien anak sakit kritis berdasarkan kadar sitrulin plasma ≤13,8 μmol/L memiliki prevalensi relatif tinggi yaitu 36%. Manifestasi klinis gastrointestinal juga sering dijumpai, tetapi diperlukan penelitian lanjutan dengan desain longitudinal dan jumlah sampel lebih besar untuk mengetahui hubungannya dengan kejadian disfungsi saluran cerna.
Kata Kunci: Disfungsi saluran cerna, sitrulin plasma, manifestasi klinis gastrointestinal, anak sakit kritis


Introduction Gastrointestinal dysfunction is frequently observed in critically ill pediatric patients. Plasma citrulline is recognized as a more precise biomarker for evaluating gastrointestinal dysfunction, with an optimal cut-off value of ≤13,8 μmol/L. This study aimed to delineate the clinical profile of gastrointestinal dysfunction in critically ill pediatric patients based on plasma citrulline levels. Method This cross-sectional study required a minimum sample size of 37 participants. Patients with hepatic, renal, or diabetic conditions were excluded. Data collection encompassed baseline characteristics, the incidence of gastrointestinal dysfunction as determined by plasma citrulline levels, and gastrointestinal clinical manifestations (including enteral nutrition intolerance, constipation (assessed specifically within the first 48 hours), abdominal distension, diarrhea, gastrointestinal bleeding, vomiting, and absence of bowel sounds) within the initial 24 hours of intensive care. Results A total of 25 subjects, with a median age of 50 months (range: 17–140) and a PELOD-2 score of 3 (range: 1–4), were enrolled. The majority were male, adequately nourished, post-surgical, non-hypoxemic, anemic, and not receiving opioids or catecholamines. The prevalence of gastrointestinal dysfunction was 36%. Gastrointestinal clinical manifestations included enteral nutrition intolerance (32%), constipation (16%), abdominal distension (16%), diarrhea (20%), gastrointestinal bleeding (20%), vomiting (12%), and absence of bowel sounds (8%). Inferential analysis to explore the relationship between gastrointestinal clinical manifestations and the incidence of gastrointestinal dysfunction based on citrulline levels could not be conducted due to an insufficient sample size. Conclusion Gastrointestinal dysfunction, defined as plasma citrulline levels ≤1 3,8 μmol/L, showed a relatively high prevalence of 36% in critically ill pediatric patients. Gastrointestinal clinical manifestations are also commonly observed. However, further longitudinal studies with larger sample sizes are warranted to elucidate the association between these manifestations and the occurrence of gastrointestinal dysfunction.
Keywords: Gastrointestinal dysfunction, plasma citrulline, gastrointestinal clinical manifestation, critically ill children