BAB V PENUTUP
C. Implikasi Penelitian
Diharapkan dengan adanya penelitian ini, dapat dipakai sebagai acuan akan adanya kemungkinan gangguan jantung pada pasien epilepsi akibat pemberian fenobarbital, yang dapat terdeteksi sejak dini dengan pemeriksaan elektrokardiogram.
2. Efek bidang Kedokteran keluarga
Diharapkan para dokter dapat mengupayakan skrining kemungkinan kelainan jantung pada pasien dengan terapi OAE, sehingga dapat mengetahui lebih awal kelainan jantung yang mungkin terjadi dan mengupayakan pencegahan atas dampak lebih lanjut dari kelainan jantung tersebut.
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Lampiran 1
Lampiran 2
PENJELASAN PENELITIAN
HUBUNGAN EFEK TERAPI FENOBARBITAL TERHADAP GAMBARAN ELEKTROKARDIOGRAM
PADA ANAK DENGAN EPILEPSI
Bagian ilmu kesehatan anak FK UNS/RSUD Dr Moewardi Surakarta sedang melaksanakan penelitian tentang hubungan efek terapi fenobarbital terhadap hasil pemeriksaan elektrokardiogram pada anak dengan epilepsi. Latar belakang penelitian ini adalah untuk mengetahui kadar kalsium dan kemungkinan adanya gangguan fungsi jantung awal. Akibat pemakaian fenobarbital jangka panjang.
Penelitian ini memerlukan pemeriksaan fisis, laboratorium dan elektrokardiografi, dimana pemeriksaan fisis meliputi pemeriksaan berat badan dan tinggi badan, pemeriksaan laboratorium meliputi pemeriksaan ion kalsium darah. Pemeriksaan ini mungkin menimbulkan rasa sakit dan rasa kurang nyaman, akan tetapi kami akan berusaha mengurangi hal ini. Semua hasil pemeriksaan akan kami informasikan kepada bapak/ibu pasien subyek penelitian. Data hasil penelitian akan kami rahasiakan.
Sangat besar harapan kami supaya bapak/ibu bersedia untuk memberikan izin sehingga putra/putri bapak ibu dapat mengikuti penelitian ini, dan kami harapkan semoga penelitian ini dapat bermanfaat pada putra/putri bapak/ibu. Apabila ada suatu hal yang kurang jelas mengenai penelitian ini, dapat menghubungi kami dr Husnia A.U di Bagian Ilmu kesehatan Anak RSUD Dr Moewardi Surakarta, atau melalui telpon 08122531547. Demikian penjelasan dari kami, terima kasih atas kepercayaan dan kerjasama yang diberikan kepada kami.
Hormat kami, dr.Husnia Auliyatul Umma
Lampiran 4
FORMULIR ISIAN PENELITIAN
Nama :...
Umur :...
BB/TB :...
Alamat :...
Tgl pemeriksaan :...
Terapi OAE yang didapatkan: Fenobarbital (dosis) :...
OAE lain (dosis):...
Kadar ion kalsium serum :...
Hasil pembacaan elektrokardiogram:...
Interval QTc :...
Lama pemberian OAE :...
Lampiran 5. Data Dasar Penelitian
No Nama umur L/P BB TB Terapi Lama
Terapi Kadar Ca ion (1,17-1,29) QTc (N ≤0,44)
1 An. A 11 th P 30 126 cm Asam valproat 12 bulan 1,07 0,35
2. An. F 5 th 4 bln P 17 98 cm Asam valproat 66 bulan 1,11 0,38
3. An. F 14 th L 32 150 cm Asam valproat 18 bulan 1,17 0,35
4. An. A 10 th 6 bln P 34 141 cm Fenobarbital 6 bulan 1,21 0,42
5. An. H 3 th P 11,2 92 cm Fenobarbital 29 bulan 1,20 0,39
6. An. A 4 th 6 bln P 12 95 cm Asam valproat 51 bulan 1,29 0,36
7. An. A 7 th P 23 113 cm Asam valproat 26 bulan 1,19 0,36
8 An. R 13 th P 38 148 cm Asam valproat 17 bulan 0,95 0,41
9. An. D 13 th P 38 kg 153 cm Fenobarbital 24 bulan 1,21 0,41 10. An. C 8 th L 22 kg 120 cm Asam valproat 26 bulan 1,15 0,40 11. An A 9 th L 25 kg 130 cm Asam valproat 24 bulan 1,17 0,35 12 An. A 12 th L 40 kg 145 cm Asam valproat 12 bulan 1,19 0,35 13. An.S 4 th 6 bln P 16 kg 98 cm Fenobarbital 14 bulan 1,20 0,43 14. An. I 13 th P 31 kg 137 cm Fenobarbital 7 bulan 1,18 0,42 15 An. R 5 tahun P 15 kg 108 cm Fenobarbital 7 bulan 1,12 0,45 16. An. A 2 th 3 bln P 12 kg 83 cm Fenobarbital 24 bulan 1,14 0,38 17 An. D 4 th 5 bl P 15 kg 104 cm Asam valproat 6 bulan 1,18 0,45 18. An. M 14 th 3 bln L 35 kg 140 cm fenobarbital 15 bulan 1,13 0,40 19. An. S 4 th 6 bln L 15kg 95 cm Asam valproat 12 bulan 1,26 0,36 20. An. R 12 th 6 bln P 28 kg 153 cm Fenobarbital 24 bulan 0,95 0,45 21. An. A 1 th 8 bln P 10 kg 88 cm Fenobarbital 12 bulan 1,15 0,40 22. An. O 3 th L 16 kg 93 cm Fenobarbital 12 bulan 0,99 0,37 23. An. A 6 th 6 bln L 19 kg 114 cm Asam valproat 12 bulan 0,88 0,35 24. An. A 8 th L 33 kg 133 cm Asam valproat 12 bulan 1,13 0,40
Lampiran 6. Hasil Pengolahan Data
Crosstabs
Case Processing Summary Cases
Valid Missing Total
N Percent N Percent N Percent
Jenis_Terapi * QTc_panjang 24 100,0% 0 0,0% 24 100,0%
Jenis_Terapi * QTc_panjang Crosstabulation
QTc_panjang Total normal mamanjang Jenis_Terapi Asam Valproat Count 12 1 13 Expected Count 11,4 1,6 13,0 % within Jenis_Terapi 92,3% 7,7% 100,0% % within QTc_panjang 57,1% 33,3% 54,2% Fenobarbital Count 9 2 11 Expected Count 9,6 1,4 11,0 % within Jenis_Terapi 81,8% 18,2% 100,0% % within QTc_panjang 42,9% 66,7% 45,8% Total Count 21 3 24 Expected Count 21,0 3,0 24,0 % within Jenis_Terapi 87,5% 12,5% 100,0% % within QTc_panjang 100,0% 100,0% 100,0% Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,599a 1 ,439 Continuity Correctionb ,024 1 ,877 Likelihood Ratio ,603 1 ,437
Fisher's Exact Test ,576 ,435
Linear-by-Linear
Association ,574 1 ,449
N of Valid Cases 24
a. 2 cells (50,0%) have expected count less than 5. The minimum expected count is 1,38.
commit to user
b. Computed only for a 2x2 table Symmetric Measures Value Asymp. Std. Errora Approx. Tb Approx. Sig. Interval by Interval Pearson's R ,158 ,198 ,751 ,461 c Ordinal by Ordinal Spearman Correlation ,158 ,198 ,751 ,461 c N of Valid Cases 24
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis. c. Based on normal approximation.
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Jenis_Terapi (Asam Valproat /
Fenobarbital)
2,667 ,208 34,197
For cohort QTc_panjang =
normal 1,128 ,819 1,553
For cohort QTc_panjang =
mamanjang ,423 ,044 4,063
N of Valid Cases 24
Explore
Jenis_Terapi
Case Processing Summary
Jenis_Terapi Cases
Valid Missing Total
N Percent N Percent N Percent
Kada_QTc Asam Valproat 13 100,0% 0 0,0% 13 100,0%
Fenobarbital 11 100,0% 0 0,0% 11 100,0%
Descriptives
Jenis_Terapi Statistic Std. Error
Kada_QTc Asam Valproat Mean ,37462 ,008742 95% Confidence Interval for Mean Lower Bound ,35557 Upper Bound ,39366 5% Trimmed Mean ,37179 Median ,36000 Variance ,001 Std. Deviation ,031521 Minimum ,350 Maximum ,450 Range ,100 Interquartile Range ,050 Skewness 1,326 ,616 Kurtosis 1,194 1,191 Fenobarbital Mean ,40936 ,007344 95% Confidence Interval for Mean Lower Bound ,39300 Upper Bound ,42573 5% Trimmed Mean ,40963 Median ,41000 Variance ,001 Std. Deviation ,024357 Minimum ,370 Maximum ,444 Range ,074 Interquartile Range ,040 Skewness -,016 ,661 Kurtosis -,846 1,279 M-Estimators Jenis_Terapi Huber's M-Estimatora Tukey's Biweightb Hampel's M-Estimatorc Andrews' Waved
Kada_QTc Asam Valproat ,36174 ,35587 ,36088 ,35560
Fenobarbital ,40951 ,40954 ,40991 ,40954
a. The weighting constant is 1,339. b. The weighting constant is 4,685.
c. The weighting constants are 1,700, 3,400, and 8,500 d. The weighting constant is 1,340*pi.
Tests of Normality
Jenis_Terapi Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Kada_QT c
Asam
Valproat ,294 13 ,003 ,796 13 ,006
Fenobarbital ,104 11 ,200* ,964 11 ,816
*. This is a lower bound of the true significance. a. Lilliefors Significance Correction
Kada_QTc
Histograms
Normal Q-Q Plots
Detrended Normal Q-Q Plots
NPar Tests
Mann-Whitney Test
Ranks
JenisTerapi N Mean Rank Sum of Ranks
KadaQTc Asam Valproat 13 9,00 117,00 Fenobarbital 11 16,64 183,00 Total 24 Test Statisticsa KadaQTc Mann-Whitney U 26,000 Wilcoxon W 117,000 Z -2,658
Asymp. Sig. (2-tailed) ,008
Exact Sig. [2*(1-tailed Sig.)] ,007b a. Grouping Variable: JenisTerapi
b. Not corrected for ties.
Nonparametric Correlations
Correlations Kada_QTc lama_feno Spearman's rho Kada_QTc Correlation Coefficient 1,000 ,470* Sig. (2-tailed) . ,020 N 24 24 lama_feno Correlation Coefficient ,470* 1,000 Sig. (2-tailed) ,020 . N 24 24*. Correlation is significant at the 0.05 level (2-tailed).
Crosstabs
Case Processing Summary Cases
Valid Missing Total
N Percent N Percent N Percent
Jenis_Terapi *
hipocalc117 24 100,0% 0 0,0% 24 100,0%
Jenis_Terapi * hipocalc117 Crosstabulation
hipocalc117 Total Ca>=1,17 Ca<1,17 Jenis_Terapi Asam Valproat Count 7 6 13 Expected Count 6,5 6,5 13,0 % within Jenis_Terapi 53,8% 46,2% 100,0% % within hipocalc117 58,3% 50,0% 54,2% Fenobarbital Count 5 6 11 Expected Count 5,5 5,5 11,0 % within Jenis_Terapi 45,5% 54,5% 100,0% % within hipocalc117 41,7% 50,0% 45,8% Total Count 12 12 24 Expected Count 12,0 12,0 24,0 % within Jenis_Terapi 50,0% 50,0% 100,0% % within hipocalc117 100,0% 100,0% 100,0% Chi-Square Tests
Value df Asymp. Sig.
(2-sided) Exact Sig. (2-sided) Exact Sig. (1-sided) Pearson Chi-Square ,168a 1 ,682 Continuity Correctionb ,000 1 1,000 Likelihood Ratio ,168 1 ,682
Fisher's Exact Test 1,000 ,500
Linear-by-Linear
Association ,161 1 ,688
N of Valid Cases 24
a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 5,50. b. Computed only for a 2x2 table
Symmetric Measures Value Asymp. Std. Errora Approx. Tb Approx. Sig. Interval by Interval Pearson's R ,084 ,203 ,394 ,698 c Ordinal by Ordinal Spearman Correlation ,084 ,203 ,394 ,698 c N of Valid Cases 24
a. Not assuming the null hypothesis.
b. Using the asymptotic standard error assuming the null hypothesis. c. Based on normal approximation.
Risk Estimate
Value 95% Confidence Interval
Lower Upper
Odds Ratio for Jenis_Terapi (Asam Valproat /
Fenobarbital)
1,400 ,279 7,016
For cohort hipocalc117 =
Ca>=1,17 1,185 ,522 2,690
For cohort hipocalc117 =
Ca<1,17 ,846 ,381 1,878
N of Valid Cases 24
Explore
hipocalc117
Case Processing Summary
hipocalc117 Cases
Valid Missing Total
N Percent N Percent N Percent
Kada_QTc Ca>=1,17 12 100,0% 0 0,0% 12 100,0%
Ca<1,17 12 100,0% 0 0,0% 12 100,0%
Descriptives
hipocalc117 Statistic Std. Error
Kada_QTc Ca>=1,17 Mean ,38708 ,010489 95% Confidence Interval for Mean Lower Bound ,36400 Upper Bound ,41017 5% Trimmed Mean ,38565 Median ,37500 Variance ,001 Std. Deviation ,036335 Minimum ,350 Maximum ,450 Range ,100 Interquartile Range ,066 Skewness ,421 ,637 Kurtosis -1,465 1,232 Ca<1,17 Mean ,39400 ,008808 95% Confidence Interval for Mean Lower Bound ,37461 Upper Bound ,41339 5% Trimmed Mean ,39367 Median ,40000 Variance ,001 Std. Deviation ,030511 Minimum ,350 Maximum ,444 Range ,094 Interquartile Range ,035 Skewness ,251 ,637 Kurtosis -,310 1,232 Tests of Normality
hipocalc117 Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Kada_QTc Ca>=1,17 ,272 12 ,014 ,864 12 ,055
Ca<1,17 ,172 12 ,200* ,921 12 ,297
*. This is a lower bound of the true significance. a. Lilliefors Significance Correction
Kada_QTc
Histograms
Normal Q-Q Plots
Detrended Normal Q-Q Plots
T-Test
Group Statistics
hipocalc117 N Mean Std. Deviation Std. Error Mean
KadaQTc Ca>=1,17 12 ,38708 ,036335 ,010489
Ca<1,17 12 ,39400 ,030511 ,008808
i
Independent Samples Test Levene's Test for
Equality of Variances
t-test for Equality of Means
F Sig. t df Sig. (2-tailed) Mean Difference Std. Error Difference 95% Confidence Interval of the Difference Lower Upper Kada QTc Equal variances assumed 1,719 ,203 -,505 22 ,619 -,006917 ,013697 -,035322 ,021488 Equal variances not assumed -,505 21,361 ,619 -,006917 ,013697 -,035371 ,021538