Pengelolan Perioperatif Stroke Hemoragik

Dewi Yulianti Bisri, Tatang Bisri

Abstract


Stroke hemoragik merupakan penyakit yang mengerikan dan hanya 30% pasien bertahan hidup dalam 6 bulan setelah kejadian. Penyebab umum dari perdarahan intrakranial adalah subarachnoid hemorrhage (SAH) dari aneurisma, perdarahan dari arteriovenous malformation (AVM), atau perdarahan intraserebral. Perdarahan intraserebral sering dihubungkan dengan hipertensi, terapi antikoagulan atau koagulopati lainnya, kecanduan obat dan alkohol, neoplasma, atau angiopati amiloid. Mortalitas dalam 30 hari sebesar 50%. Outcome untuk stroke hemoragik lebih buruk bila dibandingkan dengan stroke iskemik dimana mortalitas hanya sekitar 10-30%. Stroke hemoragik khas dengan adanya sakit kepala, mual, muntah, kejang dan defisit neurologik fokal yang lebih besar. Hematoma dapat menyebabkan letargi, stupor dan koma. Disfungsi neurologik dapat terjadi dari rentang sakit kepala sampai koma. Pengelolaan dini difokuskan pada : 1) pengelolaan hemodinamik dan jantung, 2) jalan nafas dan ventilasi, 3) evaluasi fungsi neurologik dan kebutuhan pemantauan tekanan intrakranial atau drainase ventrikel atau keduanya.


Perioperative Management of Hemorrhage Stroke

Hemorrhagic stroke is devastating disease and only 30% patients survive in 6 months after event. The common cause of intracranial hemorrhage are subarachnoid hemorrhage (SAH) from aneurysm, bleeding from arteriovenous malformation (AVM) or intracerebral hemorrhage. Intracerebral hemorrhage common correlation with hypertension, anticoagulant therapy, or other coagulopathi, drug and alcohol addict, neoplasm, or amyloid angiopathi. Mortality in 30 days is 50%. Outcome for hemorrhagic stroke worst than ischemic stroke with mortality arround 10-30%. Hemorrhagic stroke typically presents with headache, nausea, and vomiting as well as seizure and focal neurological deficits. Neurological dysfunction variated between headache untill coma. Early treatment focused on: 1) hemodynamic and cardiac, 2) airway and ventilation, 3) neurological function evaluation and the needed intracranial pressure monitoring or ventricular drainage or both.

 


Keywords


perdarahan intrakranial; stroke perdarahan; intracranial hemorrhage; stroke hemorrhagic

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References


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DOI: https://doi.org/10.24244/jni.vol1i1.81

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