Perbandingan Osmolaritas, Kadar Natrium dan Klorida Plasma setelah Pemberian NaCl–RL (3:1) dengan Ringerfundin pada Pasien Tumor Otak

Abstract

Latar Belakang dan Tujuan : Kristaloid NaCl 0,9% merupakan cairan dasar yang sering digunakan pada perioperatif pasien tumor otak, namun berpotensi menyebabkan asidosis hiperkloremia sehingga dikombinasikan dengan Ringer Laktat. Ringerfundin, kristaloid yang komposisi elektrolitnya hampir “ideal”, namun belum banyak penelitiannya dalam kasus bedah saraf. Tujuan penelitian adalah membandingkan pemberian cairan kombinasi NaCl 0,9%: RL (3:1) dengan cairan Ringerfundin pada pasien tumor otak untuk melihat osmolaritas, natrium dan klorida plasma.
Subjek dan Metode: Penelitian Randomized Controlled Trial (RCT) pada 36 pasien tumor otak yang menjalani kraniotomi, di Rumah Sakit Hasan Sadikin. Sampel dibagi menjadi kelompok NaCl 0,9%:RL (3:1) dan kelompok Ringerfundin. Dilakukan pemeriksaan natrium, klorida plasma dan osmolaritas plasma sebelum dan setelah pemberian cairan sebanyak 1 liter. Data penelitian dianalisis dengan uji t.
Hasil: Analisis statistik menunjukkan tidak terdapat perbedaan yang bermakna kedua kelompok setelah pemberian cairan dalam perhitungan osmolaritas plasma 291,42 vs 290,21 (p=0,63) dan natrium plasma 141,28 vs 141,06 (p=0,82). Terdapat perbedaan yang bermakna kadar klorida kelompok NaCl 0,9%: RL dibandingkan dengan kelompok ringerfundin 106,33 vs 104,39 (p=0,02).
Simpulan: Ringerfundin dapat menjadi cairan alternatif dari NaCl 0,9%: RL dengan tidak menyebabkan perubahan pada osmolaritas, peningkatan kadar natrium dan kadar klorida plasma.

The Comparison of Osmolarity, Plasma Natrium and Chloride Level After Administering NaCI-RL (3:1) and Ringerfundin in Brain Tumor Patients Undergoing Craniotomy

Background and Objective: One of most commonly used crystalloid for perioperative fluid administration in patients with brain tumor is NaCl 0,9%, and because it has potential to cause hyperchloremic acidosis, its administration usually combined with Ringer Lactate. Ringerfundin is a crystalloid solution which contains electrolyte composition that is considered as the most “ideal” solution, but has not been frequently used in neurosurgery procedure. The aim of this study is to compare the plasma osmolarity, sodium and chloride levels in brain tumor patient after the administration NaCl 0,9% combined with: RL solution in 3:1 ratio and after ringerfundin administration. 

Subject and Method: Thirty six patients underwent craniotomy tumor removal were assigned randomly to receive NaCl 0,9%: RL (3:1) or ringerfundin solutions. Sodium and chloride plasma level and calculated plasma osmolarity were recorded at baseline and after one liter of fluid adminisitration. Data were analyzed with by using t-test analysis.
Result: Statistic analysis showed no significant differences between the two groups in calculated plasma osmolarity
(291,42 vs 290,21; (p=0,63) and sodium plasma level (141,28 vs 141,06; (p=0,82). A significant increased in chloride plasma level after one liter of fluid administration was observed in NaCl 0,9%: RL group compared to ringerfundin group (106,33 vs 104,39 respectively; (p=0,02).
Conclusion: Ringerfundin is safe and can be use as an alternative fluid aside the most commonly used fluid combination using NaCl 0,9% and RL solutions, without causing changes in plasma osmolarity, and sodium or chloride plasma level.