Analisis Outcome Pasien Post Stroke Hyperglycemia Tanpa Terapi Antihiperglikemia

Nurul Maziyyah, Sugiyanto Sugiyanto, Inayati Inayati

Abstract


ABSTRAK Poststroke Hyperglycemia (PSH) merupakan kejadian peningkatan kadar gula darah yang signifikan setelah terjadinya serangan stroke. Kejadian PSH telah diketahui dapat menimbulkan dampak yang buruk bagi pasien. Saat ini rekomendasi terapi untuk pasien PSH adalah terapi berbasis insulin. Namun pendekatan di klinik pada kenyataannya masih berbeda–beda, salah satunya adalah tidak diberikannya terapi antihiperglikemia pada pasien-pasien tertentu. Penelitian ini bertujuan untuk mengetahui gambaran outcome pada pasien PSH yang tidak mendapatkan terapi antihiperglikemia di rumah sakit. Penelitian ini menggunakan rancangan non eksperimental secara deskriptif-analitik. Data diperoleh secara retrospektif dengan menelusuri rekam medik pasien stroke yang dirawat inap pada periode Oktober 2011–Oktober 2012 di sebuah rumah sakit swasta di Yogyakarta. Pasien dinyatakan mengalami PSH jika kadar gula darah pasien saat masuk rumah sakit ≥140 mg/dL. Pasien PSH dikelompokkan berdasarkan riwayat diabetes mellitus (DM) sebelum stroke. Analisis dilakukan terhadap outcome pasien PSH yang tidak diberikan terapi antihiperglikemia berupa kadar gula darah pasien setelah ±24 jam di rumah sakit dan kondisi pasien di akhir perawatan di rumah sakit. Hasil penelitian menunjukkan bahwa sebagian besar (96,88%) pasien PSH yang tidak mendapatkan terapi antihiperglikemia adalah pasien tanpa riwayat DM dengan baseline kadar gula darah saat masuk rumah sakit berada pada rentang 140–180 mg/dL (71,88%). Gambaran kadar gula darah setelah ± 24 jam perawatan memperlihatkan bahwa 55,38% pasien tidak terekam kadar gula darahnya sementara 33,85% mengalami penurunan dan sisanya 10,77% mengalami peningkatan kadar gula darah. Kondisi pasien di akhir perawatan sebagian besar membaik (68,75%), namun terdapat 29,69% pasien yang meninggal selama perawatan. Outcome yang beragam pada pasien PSH perlu menjadi perhatian khususnya oleh para klinisi, agar kadar gula darah pasien dapat terekam dengan jelas selama fase akut stroke di rumah sakit untuk mengambil keputusan yang tepat terkait terapi pasien. Hal ini untuk menghindari dampak buruk dari kondisi hiperglikemia (termasuk tingkatan hiperglikemia ringan) pada pasien stroke. Kata kunci: poststroke hyperglycemia, outcome, antihiperglikemia. ABSTRACT Poststroke Hyperglycemia (PSH) occurs when there is a significant increase in blood glucose level after stroke attack. PSH has been known to cause various negative effects on stroke patients. PSH therapy recommendation from various guidelines nowadays is insulin-based therapy. On the other hand, many clinicians use various approaches in overcoming this condition, one of which is not treating PSH patients (probably specific PSH patients). This study aims to describe outcomes in PSH patients untreated with antihyperglycemia agent. This study uses a non experimental design with a descriptive and analytical approach. Data was obtained retrospectively through medical records of stroke patients hospitalized from October 2011–October 2012 in a private hospital in Yogyakarta. Patients were stated as PSH if the admission blood glucose level was ≥140 mg/dL. PSH patients were classified based on their history of diabetes mellitus (DM); diabetic or non diabetic. Outcome in untreated PSH patients was described through blood glucose level after ±24 hours hospitalized and their final condition in the hospital. The result of this study showed that most of untreated PSH patients (96.88%) were non diabetic patients with a baseline of 140–180 mg/dL on their admission blood glucose level (71.88%). Outcome of blood glucose level after ±24 hours of hospitalization revealed 55.38% of the patients didn’t have their blood glucose level recorded, while 33,85% had a decrease in glucose level and the remaining 10.77% had a rise in their glucose level. Patients’ final conditions were mostly getting better (68.75%), but there were 29.69% of patients who died during hospitalization. The various outcomes seen in untreated PSH patients should give awareness for clinicians to have a complete record on patients’ blood glucose level throughout the acute phase of stroke in order to decide for the best treatment. Hence, negative effect following hyperglycemia condition (including mild hyperglycemia) in stroke patients could be prevented.. Key words: poststroke hyperglycemia, outcome, antihyperglycemia.

References


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ISSN: 2579-910X