Perbandingan antara Tindakan Dekompresi Hemikraniektomi Evakuasi dengan Kraniotomi Evakuasi terhadap Hasil Luaran Pasien Perdarahan Intraserebral Spontan dengan Glasgow Coma Scale < 9

Achmad Adam, Bilzardy Ferry, Muhammad Adam Pribadi

Abstract


Latar Belakang dan Tujuan:Prevalensi stroke di Indonesia berdasarkan data dari Kementerian Kesehatan RI tahun 2013 yang terdiagnosis tenaga kesehatan atau bergejala sebesar 12,1 per mil. Jawa barat menempati posisi ke-13 dari 33 provinsi dengan prevalensi pasien stroke 6,6 0/00. PIS spontan dapat sangat merusak dengan kematian yang tinggidalam 30 hari pertama pascaserangan. Pasien koma (GCS <9) dengan PIS merupakan suatu keadaan yang khusus karena angka mortalitas yang sangat tinggi dan tindakan terapi yang belum tepat.Tujuan penelitian ini adalah untuk menganalisis perbandingan tindakan dekompresi hemikraniektomi evakuasi dibandingkan kraniotomi evakuasi pada pasienPIS dengan GCS < 9.

Subjek dan Metode:Dilakukan penelitian ini selama bulan February-Juli 2016. Penelitian ini merupakan penelitian Kohort analitik dengan rancangan penelitian analitik komparatif. Analisis statistik akan menggunakan uji-t tidak berpasangan jika sebaran data nomal, dilanjutkan dengan Man Whitney jika sebaran data tidak normal dengan menggunakan SPSS 17.

Hasil: Didapatkan 16 sampel yang memenuhi kriteria inklusi penelitian. Didapatkan hasil perbandingan skor NIHS post operasi yang dilakukan dekompresi hemikraniektomi dengan kraniotomi yang memberikan hasil signifikan dengan p = 0,021 (p < 0,05). Sedangkan untuk midline shift post operasi dan mortalitas < 30 hari tidak memberikan perbedaan yang signifikan dengan p = 0.328 dan p = 1,00.

Simpulan:Tindakan dekompresi hemikraniektomi evakuasi memberikan hasil luaran yang lebih baik dibandingkan kraniotomi evakuasi pada pasien PIS spontan di ganglia basal dengan GCS < 9dengan tolak ukur skor NIHS

Comparison of Outcome between Evacuative Decompressive Hemicraniectomy and Craniotomy Evacuation Spontaneous Intracerebral Hemorraghe Patients with Glasgow Coma Scale < 9

Background and Objective:Indonesian stroke prevalence based upon 2013 Indonesian Health Ministry database that was diagnosed by health professionals was 12.1/mil. West Java was ranked 13 out of 33 provinces with a stroke prevalence of 6.6%. Coma patients with ICH are a special condition because of the high mortality rate and improper therapy. The aim of this study was to analyze the comparison between evacuative hemicraniectomy decompression and craniotomy evacuation upon spontaneous ICH patients with GCS < 9.

Subject and Method:This research was done during February-July 2016. The research used analytical cohort study with comparative analysis design. Employed statistical analysis was unpaired t-test with normal distribution or Mann Whitney if it was abnormal using SPSS ver. 17.      

Result:There were 16 samples that met research inclusion criteria. The results of postoperative NIHS score comparison between decompressive hemicraniectomy and craniotomy showed significant difference with p = 0.021 (p<0.05). Meanwhile for postoperative midline shift and less than 30 days mortality didn’t demonstrate significant difference with respective were p = 0.328 and p = 1.00.

Conclusion: Evacuative hemicraniectomy decompression gave better outcome compared with craniotomy evacuation upon spontaneous basal ganglia ICH patients with GCS < 9 using NIHS score assessment. 


Keywords


Dekompresi hemikraniektomi; Koma; Kraniotomi evakuasi; perdarahan intraserebral spontan; skor NIHS; Coma; craniotomy evacuation; decompressive hemicraniectomy; NIHSS; spontaneous intracerebral hemorrhage

Full Text:

PDF

References


Go GO, Park H, Lee CH, Hwang SH, Han JW, Park IS. The Outcomes of Spontaneous Intracerebral Hemorrhage in Young Adults - A Clinical Study. Journal of Cerebrovascular and Endovascular Neurosurgery. 2013;15(3):7.

Yilmaz C, Kabatas S, Gulsen S, Cansever T, Gurkanlar D, Caner H, et al. Spontaneous supratentorial intracerebral hemorrhage: Does surgery benefit comatose patients? Annals of Indian Academy of Neurology, July-September 2010. 2010;13(3):5.

Farhat H, Kretschmer T, Morcos JJ. Nonlesional Spontaneous Intracerebral Hemorrhage. In: Winn HR, editor. Youmans Neurological Surgery. 4. 6 ed. Philadelphia: Elsevier; 2011. p. 3706-29.

Hemmen TM, Zivin JA. Acute Medical Management of Ischemic/ Hemorrhagic Stroke. In: Winn HR, editor. Youmans Neurological Surgery. 4. 6 ed. Philadelphia: Elsevier; 2011. p. 3563-70.

Trihono. Riset Kesehatan Dasar RISKESDAS 2013. In: RI KK, editor. 2 ed. Jakarta. 2013; 91.

Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive Hemicraniectomy for Spontaneous Intracerebral Henorrhage. Neurosurg Focus. 2013;34(5).

Sen J, Afinowi R, Kitchen N, Belli A. Intracranial Hemorrhage: Aneurysmal, Idiopathic, And Hypertensive. In: Schapira AHV, editor. Neurolgy And Clinical Neuroscience. Philadelphia: Elsevier; 2007. p. 587.

Eddleman CS, Jaffe J, Rahme RJ, Batjer HH, Bendok BR, Awad IA. Surgical Approaches to Intracerebral Hemorrhage. In: Bendok BR, Naidech AM, Walker MT, Batjer HH, editors. Hemorrhage and Ischemic Stroke: Medical, Imaging, Surgical and Interventional Approaches. 1 ed. New York: Thieme; 2011; 356.

Broderick JP. STICH I Investigators. The STICH Trial: What Does It Tell Us and Where Do We Go From Here? strokeahajournal. 2005;36:3.

Maira G, Anile C, Colosimo C, Rossi GF. Surgical treatment of primary supratentorial intracerebral hemorrhage in stuporous and comatose patients. Neurological Research. 2002;24:7.

Fung C, Murek M, Z'Graggen WJ, Krahenbuhl AK, Gautschi OP, Schucht P, et al. Decompressive Hemicraniectomy in Patients with Supratentorial Intracerebral Hemorrhage. Stroke. 2012;43:5.

Teleanu DM. Decompressive Craniectomy In Deep Spontaneous Intracerebral Hemorrhages. Romania Journal of Neurology. 2014;8(2):3.

Aghi MK, Ogilvy CS, Carter BS. Surgical Management of Intracerebral Hemorrhage. In: Quiñones-Hinojosa A, editor. Schmidek & Sweet operative neurosurgical techniques : indications, methods, and results. 1. 6 ed. Philadelphia: Elsevier; 2012; 823.

Hayes SB, Benveniste RJ, Morcos JJ, Aziz-Sultan MA, Elhammady MS. Retrospective Comparison of Craniotomy and Decompressive Supratentorial Intracerebral Hemorrhage. Neurosurg Focus. 2013;34(5):7.

Sakero T, Kojiro W, Kimimuro N, Naoki O, Kentaro M. Decompressive hemicraniectomi for spontaneous intracerebral hemorrhage. Neurosurg focus 20113;34(5):5.

Sucharew H, Khoury J, Kleindorfer D. Profiles of the National Institutes of Health Stroke Scale items as a Predictor of Patients Outcome. Stroke. 2013;44(8):6




DOI: https://doi.org/10.24244/jni.vol6i1.32

Refbacks

  • There are currently no refbacks.


                                    

 

JNI is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License