BAB V. KESIMPULAN DAN SARAN
V.3. Keterbatasan Penelitian
2
memiliki resiko tertinggi untuk terjadi CIN dengan resiko CIN dapat meningkat hingga 12 kali lipat dengan nilai OR = 12,546 (95% i.k 4.865 – 50.743) dan p <0,001.
V.2. SARAN
1. Perlu dilakukan studi prospektif untuk menilai fungsi ginjal setelah intervensi koroner tidak hanya dalam 24 jam pertama paska tindakan, namun juga dalam 48 jam, 72 jam dan 96 jam serta 10 hari setelah tindakan intervensi koroner agar dapat dilihat perkembangan fungsi ginjal yang terjadi.
2. Perlu dilakukan penelitian lebih lanjut dengan menggunakan jumlah sampel yang lebih besar agar memberikan hasil yang lebih representatif.
V. 3. Keterbatasan Penelitian
1. Penelitian ini tidak menilai status hidrasi pasien baik pada waktu sebelum, saat dilakukan atau sesudah tindakan intervensi koroner.
2. Penelitian ini tidak ada mengintervensi obat-obatan yang diberikan sebelumnya yang mungkin dapat mempengaruhi fungsi ginjal.
3. Pengambilan sampel darah untuk menilai kadar kreatinin serum setelah tindakan intervensi koroner tidak tepat seluruhnya 24 jam paska tindakan, oleh karena keterbatasan prasarana dalam pengambilan sampel namun kelebihan waktu dalam pengambilan sampel ini tidak melebihi 4 jam.
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LEMBAR PENJELASAN Lampiran 1
Peningkatan kadar kreatinin serum 24 jam setelah tindakan intervensi koroner di RSUP.H. Adam Malik Medan.
Bapak/Ibu/Saudara/Saudari yang terhormat Assalamualaikum Wr. Wb.
Saya yang bertanda tangan di bawah ini Nama : Cut Aryfa Andra Alamat : Jl. Tri Dharma no.128 HP : 061-77786208
adalah peserta program studi dokter spesialis Fakultas Kedokteran Universitas Sumatera Utara yang akan melaksanakan penelitian dengan judul Peningkatan kadar kreatinin serum 24 jam setelah tindakan intervensi koroner di RSU.H.Adam Malik Medan.
Penggunaan zat kontras dalam tindakan diagnosa dan intervensi terus meningkat. Hal ini dapat menyebabkan gangguan fungsi ginjal akibat penggunaan zat kontras. Keadaan ini berhubungan erat dengan terjadinya gagal ginjal akut, peningkatan angka kematian selama rawatan di rumah sakit. Dari seluruh tindakan yang ada yang paling sering menimbulkan gangguan fungsi ginjal adalah kateterisasi jantung.
Gangguan fungsi ginjal akibt penggunaan zat kontras setelah tindakan kateterisasi jantung dapat dideteksi dengan mengukur kadar kreatinin darah. Apabila terjadi gangguan fungsi ginjal makakreatinin darah akan meningkat ≥ 0,5 mg/dl dari nilai dasar. Keadaan ini memiliki pengaruh yang penting pada penderita yang akan menjalani rawat jalan dan dapat menimbulkan komplikasi setelah kateterisasi jantung yaitu kematian, serangan jantung ulangan dan stroke.
Pada populasi umum gangguan fungsi ginjal akibat penggunaan zat kontras terjadi ≤ 5% tetapi mencapai 10-30% pada penderita yang telah memiliki gangguan fungsi ginjal sebelumnya. Kejadian ini juga dipengaruhi oleh faktor-faktor risiko yang ada seperti misalnya diabetes dan hipertensi.
Tujuan dari penelitian ini adalah untuk mengetahui angka kejadian penderita yang mengalami peningkatan kadar kreatinin darah 24 jam setelah kateterisasi jantung dan
faktor-faktor risiko yang mempengaruhinya. Informasi yang diperoleh dari penelitian ini diharapkan dapat member masukan pada pihak-pihak yang berkepentingan.
Penelitian dilakukan dengan mengambil sampel darah 24 jam setelah tindakan kateterisasi jantung sebanyak 5 cc oleh petugas laboratorium RSU.H.Adam Malik Medan dan dilakukan pengukuran kadar kreatinin darahnya.
Partisipasi Bapak/Ibu/Saudara/Saudari bersifat sukarela dan tanpa paksaan. Setiap data yang ada dalam penelitian ini akan dirahasiakan dan digunakan untuk penelitian. Untuk penelitian ini Bapak/Ibu/Saudara/Saudari tidak dikenakan biaya apapun.
Terima kasih saya ucapkan kepada Bapak/Ibu/Saudara/Saudari yang telah ikut berpartisipasi dalam penelitian ini. Keikutsertaan Bapak/Ibu/Saudara/Saudari akan member sesuatu yang berguna bagi ilmu pengetahuan.
Setelah memahami berbagai hal yang menyangkut penelitian ini diharapkan Bapak/Ibu/Saudara/Saudari bersedia mengikuti persetujuan yang telah dipersiapkan.
Peneliti,
Lampiran 2
PERSETUJUAN SETELAH PENJELASAN ( PSP )
Saya yang bertanda tangan di bawah ini Nama :
Umur : Jenis Kelamin : Alamat :
Setelah mendapat keterangan secara terperinci dan jelas mengenai penelitian yang berjudul “Peningkatan kadar kreatinin serum 24 jam setelah tindakan intervensi koroner di RSUP.H. Adam Malik Medan”, maka saya menyatakan bersedia untuk ikut serta dalam penelitian ini secara sukarela dan tanpa adanya paksaan dari pihak manapun.
Medan, 2010
Lampiran 3
STATUS PASIEN
Nama : Umur : tahun JK : L / P MR :
Tanggal MRS : BB : kg TB : cm SPV: Alamat / No.telp :
Anamesa Keluhan Utama :
Faktor risiko CAD : DM / HT / Obesitas / Merokok / FH / Dislipidemia /…………. / ……….
Riw.penggunaan obat : Diuretik :……….dosis………
ACEI :……….dosis………
ARB :……….dosis………...
CCB :……….dosis………
Statin :………..dosis………
Anti platelet :………..dosis………
NSAID :………..dosis………
Anti diabetikum :………dosis…………
Aminoglycoside :………dosis…………
Kemoth/ :………dosis…………
………dosis…………
………dosis…………
Riw.penyakit terdahulu : Renal insuff. / CKD dengan HD + / - CHF : Gangguan hati : Riw. Stroke :
ACS :
Peripheral vascular disease : Gout arthritis : ………. ………. Pemeriksaan Fisik TD : mmHg Nadi : x/i RR : x/i Temp: ºC EKG : Foto toraks : Laboratorium I : Hb……./ Ht….../ Leuco……. / Plt…………/ Ureum…………/
Creatinin………/ Na……./ K……../ Cl…………/ SGOT……../ SGPT…………./ KGD…………/
Echo : Fungsi sistolik LV : EF……..% Fungsi diastolik LV :………….
Kesan :
Diagnosa : ………
Masalah selama rawatan :
Laboratorium II (24 jam setelah intervensi koroner) : Ureum…………../ Creatinin…………
Tanggal coronary angiography : No. registrasi : Jenis kontras : Jumlah kontras yang digunakan : Hasil coronary angiography :
Tindakan :
Kes : TIMI Flow………
Penyulit/komplikasi selama prosedur : Hipotensi Aritmia Bradikardi …………..