PERBANDINGAN NILAI SATURASI OKSIGEN PULSE OXIMETRY DENGAN ANALISA GAS DARAH ARTERI PADA NEONATUS YANG DIRAWAT DI UNIT PERAWATAN INTENSIF ANAK

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PERBANDINGAN NILAI SATURASI OKSIGEN

PULSE OXIMETRY DENGAN ANALISA GAS DARAH ARTERI

PADA NEONATUS

YANG DIRAWAT DI UNIT PERAWATAN INTENSIF ANAK

-

e

---.

'--Dr.

M..-I8alflaiay, SpA(K)

Pembimbing

II

Dr. H. Syahril Pasaribu, DTM

&

H, MSc (CTM), SpACK)

Pembimbing 1IJ

Medan, Oktober 2002

c -_ _Cl.ie~tu~a

Program Studi

IImu Kesehatan Ana

akult

Kedokteran USU

I

Dr.

H. Muffa! LatHs, SpA(K)

NIP. 140 087 999

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I..

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RINGKASAN

Perubahan-perubahan yang cepat pada nilai gas darah arteri sering terjadi pada

penderita yang sakit kritis. Analisa gas darah arteri biasanya bermanfaat untuk

mengenali jenis gangguan pertukaran gas, keberhasilan kompensasi, dan dibutuhkan

untuk penatalaksanaan yang adekuat.

Meskipun tekanan parsial oksigen arteri (PaOz) merupakan pengukuran standar

oksigenasi darah, saturasi Oz dengan pulse oximetry (SapOz) merupakan penilaian

non invasif oksigenasi darah secara kontinyu yang sering digunakan pada neonatus.

Dengan mengkombinasi data pulse oximetry dengan nilai analisa gas darah arteri,

lebih memudahkan untuk menentukan tindakan yang tepat tentang tatalaksana

ventilasi daripada bila hanya berdasarkan penilaian analisa gas darah arteri

intenniten.

Suatu penelitian sekat lintang telah dilakukan untuk menentukan perbandingan

SapOz dengan SaOz pada neonatus yang dirawat di UPI Anak dan hubungannya

dengan beberapa

faktor

lainnya, serta prediksi nilai tekanan parsial Oz arteri (PaOz)

berdasarkan nilai SapOz. Tiga puluh neonatus usia 2 - 672 jam (usia rerata 143,8

jam) yang dirawat di UPI Anak selama periode I Februari 2001 sampai 31 Mei 2002

dimasukkan sebagai sampel penelitian. Semua sampel dilakukan pemeriksaan saturasi

O

2

dengan pulse oximetry Ohmeda Biox 3740 (BOC Health Care, USA) dan analisa

gas darah arteri dengan

Goa-Corning 280

sel/llra

bersamaan,

Selilillitu

Juga

34

(54)

35 dilakukan pemeriksaan berar badan (1313), tekanan darah (ID), frekuensi jantung (FJ),

frekuensi

nadi (FN), frekuensi

pernapasan (FP), temperatur tubuh (Tr) dan

permukaan tubuh (Ts), serta hemoglobin (Hb).

Perbedaan rerata SaOz dan SapOz adalah 1,77 (SB 4,636)

%

dengan "limit of

agreement" -7,502%

dan 11,042%. Hal ini menunjukkan bahwa Ohmeda Biox 3740

pulse oximetry

tidak dapat digunakan sebagai pengganti AGDA untuk tujuan klinis.

Dijumpai hubungan yang bermakna dengan korelasi positif yang tidak kuat

antara FJ dan FN dengan

TCOz

dan BC0

3;

FP dengan PaOz,

TCOz,

BC0

3,

dan BE;

Tr dengan BC0

3

dan BE; Ts dengan pH,

TCOz

BC0

3,

dan BE. Selain itu didapatkan

adanya korelasi positif yang bermakna antara SapOz dengan pB (r

=

0,41), dan PaOz

(r

=

0,40);

serta

korelasi

negatif yang bermakna antara SapOz dengan PaCOz

(r

=

-0,45)

Untuk memprediksikan ni1ai PaOz (y) berdasarkan nilai SapOz (x) pada

penelitian ini, didapatkan persamaan regresi linear

y

=

-79,828

+

1,912

x.

Dengan titik potong 90%, uji diagnostik menunjukkan sensitivitas pulse oximetry

Ohmeda Biox 3740

adalah 85,7%; spesifisitas 66,7%; likelihood ratio for a positive

test result

2,57; likelihood ratio for a negative test result 0,21; nilai prediksi positif

85,7%; nilai prediksi negatif M,7%;aImrasi 80,0%; pre-test probability (prevalens)

70,0%; dan pre-test odds 2,33.

(55)

L

SUMMARY

Rapid changes in arterial blood gas values arc common in critically ill patients.

Arterial blood gas is usually beneficial to discern the nature of gas exchange

disturbances, the effectiveness of compensation, and is required for adequate

management.

Although arterial partial pressure of oxygen is the standard measure of blood

oxygenation, arterial pulse oxygen saturation is now a customary noninvasive

assessment of blood oxygenation in neonates. By combining pulse oximetry data with

blood gas val ues, the authors have found it much easier to made appropriate decisions

about ventilatory management than if they were to rely entirely on intermittently

determined arterial blood gas values.

The cross-sectional study was conducted to determine the comparison between

oxygen saturation in the neonates using pulse oximetry and arterial blood gas

analysis, it's correlation with other variables, and the prediction of Pa02 based on

Sap02 values. Thirty neonates with a mean age 143,8 hours (range 2 - 672 hours)

whose admitted to Pediatric Intensive Care Unit H. Adam Malik Hospital between

February 1

st

2001

and May 31

st

2002

were included in this study. Oxygen saturation

had measured similarly with

Ohmeda Biox 3740 pulse oximetry (BOC Health Care,

USA)

and arterial blood gas analysis with

Ciba-Corning 280.

The body weight (BW),

blood pressure (BP), heart rate (HR), pulse rate (PR), respiratory rate (RR), body (Tr)

and surface (Ts) temperature, and hemoglobin (Hb) were recorded, too.

36

(56)

37 The mean differences between Sa02 and Sap02 was

1,77

(SD

4,636)

%

with

"limit of agreement" was

-7,502%

and

11,042%.

Despite this, the

Ohmeda Biox 3740

pulse oximetry

can not be used in place of the arterial blood gas analysis for clinical

purposes.

There were significant positive correlations between

HR

and PR to TC02 and

HCO]; RR to Pa02, TC02, HCO], and BE; Tr to HC03 and BE; Ts to pH, TC02,

HCO], and BE; but there were not closely correlations. In addition to, Sap02

correlated positively with pH (r

=

0,41;

p

<

0,05)

and Pa02 (r

=

0,40;

and Sap02

correlated negatively with PaC02 (r

=

-0,45;

p

<

0,05)

To predict Pa02 (y) based on Sap02 (x) values, the linear regression equation

wasy

=

-79,828

+

1,912

x.

With cut-off point

90%,

diagnostic test showed that the sensitivity of

Ohmeda

Biox 3740 pulse oximetry

was

85,7%;

specificity was

66,7%;

likelihood ratio for a

positive test result was

2,57;

likelihood ratio for a negative test result was

0,21;

positive predictive value was

85,7%;

negative predictive value was

66,7%;

accuracy

was

80,0%;

pre-test probability (prevalence) was

70,0%;

and pre-test odds was

2,33.

MILlK

PERPUST AKAAN

UNIVER5W,5

~\!!lI(\\~!\i\

UHila

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