| dc.description.abstract | Latar Belakang : Pada trauma kapitis sedang dan berat terjadi stimulasi aksis Hypothalamo-Pituitary-Adrenal (HPA), aktivasi sel imunokompeten yang menyebabkan pelepasan mediator inflamasi. Peningkatan sitokin menyebabkan stimulasi aksis HPA yang menyebabkan terpacunya pelepasan hormon kortisol oleh korteks adrenal. Tujuan penelitian ini adalah untuk mengetahui hubungan kadar kortisol dalam darah dan nilai Skala Koma Glasgow (SKG) dengan outcome hari ke-3 pada penderita trauma kapitis sedang-berat. Metodologi : Studi ini merupakan studi prospektif dengan kelompok pembanding. Pengambilan sampel dilakukan secara non random dengan metode konsekutif pada pasien trauma kapitis di ruang rawat inap neurologi dan Poliklinik Kesehatan RSUP H.Adam Malik Medan, periode Januari 2007 sampai Mei 2007. Dilakukan pemeriksaan fisik, SKG dan kadar kortisol darah pada semua penderita trauma kapitis dengan onset < 48 jam dan dinilai outcome hari ke-3. Untuk kelompok pembanding dilakukan pemeriksaan fisik dan pemeriksaan kadar kortisol darah. Untuk mengetahui perbedaan kadar kortisol darah yang meningkat dan yang tidak meningkat menurut SKG digunakan uji Chi-square. Perbedaan rerata kadar kortisol darah penderita trauma kapitis dengan kelompok pembanding digunakan uji t-berpasangan. Nilai kemaknaan, p< 0,05. Hasil : Diteliti 46 penderita trauma kapitis (89,1% pria) dan 23 orang pembanding (95,7% pria). Pada kelompok trauma kapitis terdapat 52,2% penderita mati pada 3 hari perawatan pertama. Rerata kadar kortisol darah penderita trauma kapitis adalah 762,28±320,52 nmol/l, sedangkan rerata nilai SKG adalah 8,11±3,25. Terdapat hubungan yang bermakna antara kadar kortisol dengan nilai SKG dimana pada nilai SKG 3-6 kadar kortisol darah paling tinggi (p=0,018). Rerata kadar kortisol pada outcome kematian lebih tinggi bermakna dengan outcome hidup yaitu 931,40 ± 295,80 nmol/l (p=0,000). Titik potong kadar kortisol untuk kematian adalah 621,7 nmol/l dengan spesifisitas 66% dan sensitifitas 93%. Pada nilai SKG 3-8, 69,2% penderita mati. Terdapat hubungan yang bermakna antara nilai SKG dengan outcome kematian. Rerata kadar kortisol darah pada kelompok pembanding lebih rendah dan berbeda bermakna dibandingkan kelompok trauma kapitis yaitu 268,88 ± 91,45 nmol/l (p=0,001) Kesimpulan : Outcome kematian pada penderita trauma kapitis sedang-berat menunjukkan kadar kortisol darah yang lebih tinggi dan nilai SKG yang lebih rendah dibandingkan dengan outcome hidup. | en_US |
| dc.description.abstract | Background : In moderate and severe head injury, Hypothalamo-Pituitary-Adrenal (HPA) axis is stimulated, activation of immunocompetent cell that causes inflamation mediators. The increasement of cytokin level causes stimulation of HPA axis that will cause release of cortisol hormone by adrenal cortex. The objective of this study was to determine the correlation between blood cortisol level and Glasgow Coma Scale (GCS) score and day-3 outcome in moderate severe head injury patients. Methods : This study was a prospective study with comparison group. The sampling method was non-random consecutive for head injury patients who was admitted in Neurologic ward and out patient clinic RSUP.H. Adam Malik Medan, between the period of January-May 2007. Physical examination was performed, GCS score was evaluated and blood cortisol level was measured for all head injury patients with onset<48 hour and outcome was determined on day 3. For the comparison group, physical examination was perfomed and cortisol blood level was measured. To determine the difference of blood cortisol level between the increased and not, based on GCS, Chi-square test was used. The difference of mean of blood level between the head injury patients and comparison group, t-paired test was used.The value of significant was 0,05. Result : Fourthy six head injury patients were examined (89,1% men) and 23 were comparison (95,7% men). In the head injury group, there were 52,2% of the patients died in the first 3 days of treatment. The mean of blood cortisol level in head injury patients was 762,28 ± 320,52 nmol/l, meanwhile the mean of GCS score was 8,11 ± 3,25 . There was a significant relationship between blood cortisol level and the GCS score, where in GCs score 3-6 the blood cortisol level was the highest (p=0,018). The mean of cortisol level in death outcome was significantly higher than survive outcome, which was 931,40 ± 295,80 nmol/l (p=0,000). The cut of point for cortisol level in death outcome was 621,7 nmol/l with 66% specificity and 93% sensitivity. In GCS score 3-8, 69,2% of the patients died. There was a significant relationship between GCS score and death outcome. The mean of blood cortisol level in the comparison group was lower and was significantly different compared to the head injury group, which was 268,88 ± 91,45 nmol/l (p=0,001). Conclusion : Death outcome in moderate-severe head injury patients showed higher blood cortisol and lower GCS score compared to survive outcome. | en_US |
