Perbandingan Efektivitas Natrium Laktat dengan Manitol untuk Menurunkan Tekanan Intrakranial Penderita Cedera Kepala Berat

Abstract

Peningkatan tekanan intrakranial masih menjadi penyebab utama kematian pada penderita cedera kepala. Penggunaan obat baru sebagai terapi osmosis diharapkan mampu menurunkan tekanan intrakranial. Penelitian prospektif, samar ganda, acak dilakukan terhadap 20 penderita cedera kepala berat di Unit Gawat Darurat (UGD) Rumah Sakit Dr. Hasan Sadikin Bandung selama bulan Februari–Juli 2009. Penderita dikelompokkan dalam 2 kelompok yang mendapat terapi manitol atau natrium laktat. Dilakukan pengukuran tekanan intrakranial, kadar laktat, kadar natrium, serta kalium sebelum dan sesudah terapi osmosis dengan uji Shapiro-Wilk untuk analisis distribusi dan uji t berpasangan atau uji Wilcoxon untuk perbandingan rata-rata mempergunakan program statistical products and solution services (SPSS). Kelompok natrium laktat mengalami penurunan tekanan intrakranial (p<0,001) serta kenaikan kadar laktat (p=0,035). Kelompok manitol mengalami penurunan tekanan intrakranial (p=0,005) dan perubahan kadar laktat (p=0,135). Kadar natrium dan kalium pada kedua kelompok tidak terdapat perubahan yang bermakna. Penurunan tekanan intrakranial kelompok manitol dan natrium laktat tidak berbeda bermakna (p=0,417). Kadar laktat antara kelompok natrium laktat dan manitol berbeda bermakna (p=0,016), yaitu kenaikan kadar laktat yang lebih tinggi pada kelompok natrium laktat. Simpulan, pemberian natrium laktat dan manitol sama efektifnya menurunkan tekanan intrakranial pada penderita cedera kepala berat. Pemberian natrium laktat meningkatkan kadar laktat secara bermakna dibandingkan dengan pemberian manitol. Tidak terdapat perbedaan bermakna kadar natrium dan kalium pada kedua kelompok penelitian. [MKB. 2012;44(1):26–31].Comparisson between Natrium Lactate and Mannitol Effectivity in Decreasing Intracranial Pressure in Severe Head Injury PatientsIncreasing of intracranial pressure still a main cause of death in head injury patient. A new osmotic therapy probably an alternative to decrease intracranial pressure. A prospective randomized double blind study was done in 20 severe head injury in Dr. Hasan Sadikin Hospital Bandung emergency unit during February–July 2009. Subjects were divided in 2 groups, the first group was treated by natrium lactate and the second group was mannitol. We measured intracranial pressure, lactate concentration, potassium and natrium concentration before and after treatment. The statistical analysis were performed by using Shapiro-Wilk test for distribution analysis and paired t-test or Wilcoxon test for mean comparison using statistical products and solution services (SPSS) program. Intracranial pressure decreased in natrium lactate group (p<0.001) with increased of lactate concentration (p=0.035). In mannitol group we get a decreased in intracranial pressure (p=0.005), and in lactate concentration (p=0.135). No significant changed of potassium and natrium concentration in each group. No significant intracranial decrease for natrium lactate versus mannitol was apreciated (p=0.417), but a significant different in lactate concentration (p=0.016). We noticed lactate concentration in natrium lactate had a higher increase. In conclusions, we noticed a significant intracranial pressure decreased by manitol as same as natrium lactate treatment. Natrium lactate administration was increasing lactate concentration significantly than mannitol done. No significant difference in natrium and potassium was noticed in both groups. [MKB. 2012;44(1):26–31].  DOI: http://dx.doi.org/10.15395/mkb.v44n1.74Â