Komplikasi Autonomic Dysreflexia Pasca Cedera Medula Spinalis

Dimas Rahmatisa, Iwan Fuadi, Sudadi Sudadi

Abstract


Cedera medula spinalis merupakan kejadian yang sering dijumpai di Amerika Serikat, dengan biaya perawatan kesehatan seumur hidup yang tinggi berdasarkan tingkat kecacatan fungsional. Permasalahan yang timbul dapat berupa masalah psikologis, fisik, dan sosial, yang dapat menghabiskan biaya yang sangat besar. Tatalaksana kasus cedera medula spinalis terus menjadi tantangan pada tiap fase perawatan, mulai dari awal terjadinya cedera, hingga perawatan dan pemulihan pasca tindakan operasi, karena angka masuk ulang ke rumah sakit pasca perawatan tetap tinggi. Salah satu komplikasi cedera medula spinalis adalah adanya perubahan sistem saraf autonom dapat terjadi akibat kerusakan pada kontrol simpatis sehingga menyebabkan komplikasi yang dikenal sebagai autonomic dysreflexia (AD), yang muncul selama fase pemulihan. Manifestasinya dapat berupa hipertensi berat dengan bradikardia paradoks, kemerahan kulit, dan sakit kepala, penyakit ini dapat menyebabkan kecacatan jangka panjang dan gangguan kardiovaskular. Terapi untuk pasien dengan AD umumnya bertujuan untuk pemulihan gejala dengan cepat hal ini sangat penting karena karena dapat terjadi komplikasi parah yang mengancam jiwa bila gejala yang ada tidak ditangani dengan segera. Pencegahan yang tepat, pengenalan dini, dan manajemen akut adalah faktor penting dalam tatalaksana AD.

 

Autonomic Dyreflexia Complication after Spinal Cord Injury

Abstract

Spinal cord injury is a common occurrence in the United States, with high lifetime health care costs based on the level of functional disability. Problems that arise can be psychological, physical, and social problems, which can cost a lot of money. Management of spinal cord injuries continues to be a challenge in each phase of treatment, from the beginning of the injury, to treatment and recovery after surgery, because the rate of re-entry to the post-treatment hospital remains high. One complication of spinal cord injury is the presence of autonomic nervous system changes that can occur due to damage to sympathetic control resulting in complications known as autonomic dysreflexia (AD), which appears during the recovery phase. The manifestation can be life-threatening hypertension with paradoxical bradycardia, flushing, and headache, this disease can cause further long-term disability and cardiovascular disorders. Therapy for patients with AD generally aims to recover symptoms quickly this is very important because because there can be severe life-threatening complications if the symptoms are not treated immediately. Proper prevention, early recognition, and acute management are important factors in the maangement of AD.


Keywords


disrefleksia autonom; cedera medula spinalis; hipertensi; autonomic dysreflexia; spinal cord injury; hypertension

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References


National Spinal Cord Injury Statistical Center. Facts and Figures at Glance. Birmingham, AL: University of Alabama at Birmingham; 2015. Diunduh dari: https://msktc.org/lib/docs/Data_Sheets_/SCIMS_Facts_and_Figures_2017_August_FINAL.pdf. Diakses tanggal 20 Mei 2019

Jallo J, Vaccaro A. Autonomic dysreflexia. Dalam: Neurotrauma and Critical Care of the Spine. 2nd ed. New York: Thieme Medical Publishers, Incorporated; 2018.

Dryden D, Saunders L, Jacobs P, Schopflocher D, Rowe B, May L, Yiannakoulias N, Svenson L and Voaklander D. Direct health care costs after traumatic spinal cord injury. The Journal of Trauma: Injury, Infection, and Critical Care.2005;59(2): 443–49.

Krassioukov A. Autonomic function following cervical spinal cord injury. Respiratory Physiology & Neurobiology. 2009; 169(2): 157–64.

Cragg J, Noonan V, Krassioukov A, Borisoff J. Cardiovascular disease and spinal cord injury: Results from a national population health survey. Neurology. 2013; 81(8): 723–28.

Lee E, Joo M. Prevalence of autonomic dysreflexia in patients with spinal cord injury above T6. BioMed Research International. 2017;2017:1–6.

Krum H, Brown D, Rowe P, Louis W, Howes L. Steady state plasma [3H]—noradrenaline kinetics in quadriplegic chronic spinal cord injury patients. Journal of Autonomic Pharmacology. 1990;10(4):221–26.

Blackmer J. Rehabilitation medicine: autonomic dysreflexia. Canadian Medical Journal. 2003; 169 (9): 931–34.

Krassioukov A, Weaver L. Reflex and morphological changes in spinal preganglionic neurons after cord injury in rats. Clinical and Experimental Hypertension. 1995;17(1-2): 361–73

Krenz N, Weaver L. Sprouting of primary afferent fibers after spinal cord transection in the rat. Neuroscience. 1998; 85(2): 443–58.

Krassioukov A, Weaver L. Morphological changes in sympathetic preganglionic neurons after spinal cord injury in rats. Neuroscience. 1996; 70(1): 211–25.

Eldahan K, Rabchevsky A. Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management. Autonomic Neuroscience. 2018;209:59–70.

Wan D, Krassioukov A. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. The Journal of Spinal Cord Medicine. 2013; 37(1): 2–10.

Petsas A, Drake J. Perioperative management for patients with a chronic spinal cord injury. BJA Education. 2015;15(3):123–30.

Lyford K, Borowczyk K, Danielleto S, Vlok R. Recognition and management of intraoperative autonomic dysreflexia. Journal of Surgery and Emergency Medicine. 2016; 1:e102:1–2




DOI: https://doi.org/10.24244/jni.v8i3.234

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DOI:  https://doi.org/10.24244/jni 

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