Perbandingan Pemberian Cairan Ringerfundin Saat Anestesi Spinal (Coload) Dengan Cairan HES Sebelum Anestesi Spinal (Preload) Terhadap Hemodinamik Ibu Dan Skor APGAR BayiPada Seksio Sesarea

Erik Efendi, Ruli Herman Sitanggang, Tinni T. Maskoen

Abstract


Hipotensi merupakan komplikasi yang paling sering ditemukan pada anestesi spinal yang dilakukan pada bedah sesar. Salah satu usaha pencegahan yang dilakukan adalah dengan cara pemberian cairan kristaloid secara coloading atau cairan koloid dengan cara preloading. Penelitian ini bertujuan untuk mengetahui pengaruh jenis cairan dan teknik pemberian mana yang paling baik dalam menjaga hemodinamik ibu dan pengaruhnya terhadap bayi. Penelitian ini dilakukan dengan desain eksperimental acak tersamar tunggal mengikutsertakan42 ibu hamilASA II, yang menjalani operasi bedah sesardengan anestesi spinal. Setelah dilakukan randomisasi secara blok permutasi, subyek penelitian dikelompokkan menjadi dua yaitu 21 subyek masuk dalam kelompok kontrol mendapat preloading HES 6%sebanyak 7,5 cc/kgbb dan 21 subyek masuk dalam kelompok perlakuan mendapat coloading Ringerfundin sebanyak 20 cc/kgbb mL. Tekanan darah danlaju nadi diperiksa setiap satu menit sampai 15 menit setelah anestesia spinal. Setelah itu diperiksa tiap 3 menit sampai operasi selesai. Setelah bayi lahir dilakukan penilaian skor APGAR 1 menit dan 5 menit. Data hasil penelitian dianalisis dengan uji statistik yaitu uji t test, uji Mann Whitney dan uji Kolmogorov-Smirnov, di mana nilai p<0,05 dianggap bermakna. Analisis statistik menunjukkan bahwa tidak ada perbedaan yang bermakna antara tekanan darah sistolik, tekanan diastolik, tekanan darah rerata dan laju nadi antara pemberian cairan ringerfundin secara coloading dibandingkan pemberian cairan HES 6% secara preloading (p>0,05). Tidak terdapat perbedaan yang bermakna antara kedua kelompok perlakuan terhadap skor APGAR 1 menit (p=0,309) dan 5 menit (p=0,154). Terdapat perbedaan bermakna terhadap jumlah pemakaian efedrin antara kedua kelompok (p=0,047). Simpulan dari penelitian ini adalah pemberian coloading ringerfundin dapat mencegah terjadinya hipotensi pasca anestesi spinal sama baiknya dengan pemberian preloading HES 6%. Tidak terdapat perbedaan skor APGAR antara preloading HES 6% dengan coloading ringerfundin. Terdapat perbedaan jumlah pemberian efedrin antara preloading HES 6% dan coloading ringerfundin.

Kata Kunci:anestesi spinal, coloading, preloading, ringerfundin, seksio sesarea

 

Comparison of Maternal Hemodynamic and APGAR Outcome between Ringerfundin Coload And HES Preload on Spinal Anesthesia for Sectio Cesarea

Hypotension is the most common complication inspinal anesthesia in cesarean sections performed. One of the prevention neffort is made by way of a coloading crystalloid fluid administration or by preloading colloid fluid. This study aims to determine the effect of fluid types and techniques of which the most excellent in maintaining hemodynamic effects on mother and baby. The research was conducted with a single-blind randomized experimental design included 42 pregnant women ASAII, who underwent cesarean section surgery with spinal anesthesia. After randomization in blocks of permutations, subjects are grouped into two, 21 subjects included in the control group received. 6% HES preloading by 7.5 cc/kg and 21 subjects included in the treatment group received coloading Ringerfund in as much as 20 cc/kg. Blood pressure and pulse rate examined everyone minute until 15 minutes after spinal anesthesia. After it examined every 3 minutes until the operation is complete. After the baby is born an assessment of Apgar score 1 minute and 5 minutes. Data were analyzed with the results of statistical tests that test, Mann Whitney test and Kolmogorov – Smirnov test, where pvalues<0.05 were considered significant. Statistical analysis showed that there was no significant difference between the systolic blood pressure, diastolic pressure, mean blood pressure and pulse rate between the coloading ringer fund in than preloading HES 6% (p>0.05). There were no significant differences between the two treatment group sof1-minute Apgarscore (p =0.309) and 5 minutes (p=0.154). There is a significant difference to the amount of ephedrine usage between the two groups (p =0.047). The conclusions of this study is the provision of coloading ringer fundin can prevent hypotension after spinal anesthesia as well as HES 6% preloading. No difference between the Apgar scores of 6% HES preloading with coloading ringer fundin. There is a difference between the amount of ephedrine administration preloading HES 6% and coloading ringer fundin.

Keyword: coloading, preloading, ringerfundin, sectio sesarea, spinal anesthesia

 

DOI: 10.15851/jap.v1n1.157


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