PDF (Daftar Pustaka) - Universitas Diponegoro

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DAFTAR PUSTAKA

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May

21

;

cited

2010

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Available

from

:

http://www.ninds.nih.gov/news_and_events/news_articles/pressrelease_str oke_outcome_063001.htm

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JUDUL PENELITIAN PENGARUH KADAR GLUKOSA DARAH SEWAKTU TERHADAP KELUARAN NEUROLOGIK PADA PENDERITA STROKE ISKEMIK FASE AKUT NONDIABETIK INSTANSI PELAKSANA

: RS DR. KARIADI SEMARANG

PERSETUJUAN SETELAH PENJELASAN (INFORMED CONSENT)

Berikut ini naskah yang akan dibacakan pada Responden / Keluarga Responden Penelitian : Bapak / Ibu / Sdr Yth Anda terpilih sebagai responden penelitian yang berhubungan dengan kadar glukosa darah sewaktu sebagai faktor risiko pada penderita stroke yang anda / keluarga anda alami. Tindakan yang akan Bapak / Ibu / Sdr alami : Dilakukan anamnesis (menggunakan kuesioner) dan pemeriksaan fisik neurologik (menggunakan palu reflek dan senter). Pengambilan sampel darah untuk pemeriksaan kadar glukosa darah yang akan dilaksanakan 2 kali, pertama saat pasien masuk ke bangsal rawat inap penyakit saraf dan kedua setelah 24 jam berikutnya. Dilakukan penilaian status neurologik menggunakan skor NIHSS pada perawatan hari ke 0, 1 dan saat pasien pulang atau hari ke 7. Terimakasih atas kerjasama Bapak / Ibu / Sdr. Setelah mendengar dan memahami penjelasan peneliti, dengan ini saya menyatakan SETUJU / TIDAK SETUJU untuk ikut sebagai responden penelitian. Semarang, ................................ Peserta penelitian

(

Saksi

)

(

Peneliti

)

(dr. Edward Y.N)

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DAFTAR PERTANYAAN DATA DASAR PENELITIAN NO. 1 2 3 4

PERTANYAAN IDENTITAS Nomor penelitian Tanggal pemeriksaan Nama Alamat

5 6 7

Nomor CM/Register Tanggal/jam masuk RS Jenis kelamin

8 9

Umur (tahun) Status perkawinan

10

Pendidikan

11

Pekerjaan

12 13 14

ANAMNESIS Defisit neurologis Tanggal/jam serangan Kedinian datang ke RS

15

Riwayat DM

16

Riwayat hipertensi

17

Riwayat merokok

18

PEMERIKSAAN FISIK Tinggi badan (cm)

JAWABAN

1. Laki-laki 2. Perempuan 1. Kawin 2. Janda/duda 3. Belum kawin 1. SD 2. SLTP 3. SLTA 4. S1 5. Tidak sekolah 1. PNS / TNI 2. Wiraswasta 3. Pedagang 4. Buruh / Tani 5. Tidak bekerja

1. < 48 jam 2. 49 - 72 jam 1. Ya 2. Tidak 1. Ya 2. Tidak 1. Ya 2. Tidak

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19 20

Berat badan (kg) Body Mass Index

21 22 23 24 25 26

Glasgow Coma Scale Tekanan darah (mmHg) Nadi (x/menit) Suhu (°C) Pernafasan (x/menit) Jantung

27

Pemeriksaan EKG

31

PEMERIKSAAN NEUROLOGIS Skor NIHSS < 48 jam onset Skor NIHSS 49 - 72 jam onset Skor NIHSS hari ke 7 onset PEMERIKSAAN PENUNJANG Lokasi infark

32 33 34 35 36

Kadar Hb (gr%) Leukosit (mm3) Trombosit (mm3) Hematokrit (%) Kadar glukosa darah sewaktu

37 38 39 40

Kadar kolesterol total (mg%) Kadar Trigliserida (mg%) Kadar HDL (mg%) Kadar LDL (mg%) KETERANGAN Alasan pulang sebelum hari ke 7 onset

28 29 30

41

1. Kurus (< 18,5) 2. Nomal (18,5-25) 3. Overweight (25-30) 4. Obesitas (> 30)

1. Normal 2. Tidak normal 1. Normal 2. Tidak normal

1. Kortikal 2. Subkortikal 3. Batang otak 4. Campuran 5. Normal

1. < 48 jam onset 2. 49 - 72 jam onset 3. Hari ke 7 onset

78

NATIONAL INSTITUTES OF HEALTH STROKE SCALES (NIHSS)

NIHSS 1a

1b

1c

2

3

4

5a

5b 6a

Derajat kesadaran 0 = sadar penuh 1 = somnolen 2 = stupor 3 = tidak respon atau hanya terdapat reflek Menjawab pertanyaan 0 = dapat menjawab dua pertanyaan dengan benar (misalnya bulan apa sekarang dan usia pasien) 1 = hanya dapat menjawab satu pertanyaan dengan benar / tidak dapat berbicara karena terpasang pipa endotrakeal atau disartria 2 = tidak dapat menjawab kedua pertanyaan dengan benar / afasia / stupor Mengikuti perintah 0 = dapat melakukan dua perintah dengan benar (misalnya buka dan tutup mata, kepal dan buka tangan pada sisi yang sehat) 1 = hanya dapat melakukan satu perintah dengan benar 2 = tidak dapat melakukan kedua perintah dengan benar Gerakan mata konyugat horisontal 0 = normal 1 = kelumpuhan parsial 2 = deviasi konyugat yang kuat atau paresis konyugat total pada kedua mata, tidak dapat diatasi dengan manuver okulosefalik Lapangan pandang pada tes konfrontasi 0 = tidak ada gangguan 1 = hemianopia parsial 2 = hemianopsia total 3 = hemianopsia bilateral (termasuk juga buta kortikal) Paresis wajah 0 = normal 1 = paresis ringan (sulkus nasolabialis mendatar, terdapat asimetri) 2 = paresis parsial (paresis total/hampir total wajah bagian bawah) 3 = paresis total (tidak ada gerakan dari wajah atas dan bawah) Motorik lengan kiri 0 = tidak ada simpangan bila pasien disuruh mengangkat lengannya pada posisi 90°/45° selama 10 detik 1 = lengan menyimpang ke bawah sebelum 10 detik 2 = lengan terjatuh ke kasur atau badan atau tidak dapat diluruskan secara penuh 3 = tidak dapat melawan gravitasi 4 = tidak ada gravitasi 9 = tidak dapat diperiksa Motorik lengan kanan (idem) Motorik tungkai kiri 0 = tidak ada simpangan bila pasien disuruh mengangkat tungkai pada posisi 30° selama 5 detik 1 = tungkai menyimpang ke bawah sebelum 5 detik 2 = tungkai terjatuh ke kasur atau tidak dapat diluruskan secara penuh 3 = tidak dapat melawan gravitasi 4 = tidak ada gravitasi 9 = tidak dapat diperiksa

1

2

3

79

6b 7

Motorik tungkai kanan (idem) Ataksia anggota badan 0 = tidak 1 = pada satu sisi 2 = pada kedua sisi 9 = tidak dapat diperiksa 8 Sensorik 0 = normal 1 = defisit ringan-sedang 2 = defisit berat (gangguan rasa raba pada wajah, lengan dan tungkai) 9 Bahasa terbaik 0 = tidak ada afasia 1 = afasia ringan sedang 2 = afasia berat 3 = mutisme 10 Disartria 0 = artikulasi normal 1 = disartria ringan sedang (masih dapat dimengerti) 2 = disartria berat 9 = tidak dapat diperiksa 11 Neglect / tidak ada atensi 0 = tidak ada 1 = gangguan bilateral dari salah satu modalitas berikut : pengenalan personal, visual, taktil, dan spasial 2 = gangguan pada lebih dari satu modalitas SKOR TOTAL NIHSS

80

HASIL ANALISIS DATA Je nis ke lam in * Kate gori NIHSS hari ke 7 Cros s tabulation

Ringan Jenis kelamin

Laki-laki Perempuan

Total

Count % of Total Count % of Total Count % of Total

7 21,9% 5 15,6% 12 37,5%

Kategori NIHSS hari ke 7 Sedang Berat Sangat berat 9 1 2 28,1% 3,1% 6,3% 7 1 0 21,9% 3,1% ,0% 16 2 2 50,0% 6,3% 6,3%

Total 19 59,4% 13 40,6% 32 100,0%

Des criptives Umur

Mean 95% Conf idence Interval f or Mean

Statistic 53,94 50,58

Low er Bound Upper Bound

Std. Error 1,649

57,30

5% Trimmed Mean Median Varianc e Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis

53,85 53,00 86,964 9,325 34 74 40 13 ,188 -,155

,414 ,809

um ur 51 * Kategori NIHSS hari k e 7 Cross tabulation

Ringan umur 51

30) Count % w ithin Count % w ithin

BMI BMI BMI BMI

7 35,0% 4 40,0% 1 50,0% 12 37,5%

Kategori NIHSS hari ke 7 Sedang Berat Sangat berat 11 1 1 55,0% 5,0% 5,0% 5 0 1 50,0% ,0% 10,0% 0 1 0 ,0% 50,0% ,0% 16 2 2 50,0% 6,3% 6,3%

Total 20 100,0% 10 100,0% 2 100,0% 32 100,0%

82

Des criptives GDS < 48 jam

Mean 95% Confidence Interval for Mean


5% Trimmed Mean Median Variance Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis

Statistic 117,47 106,74

Std. Error 5,260

128,20 115,69 106,00 885,289 29,754 73 194 121 35 1,073 ,639

,414 ,809

Tes ts of Norm ality a

GDS < 48 jam

Kolmogorov-Smirnov Statistic df Sig. ,187 32 ,006

Statistic ,904

Shapiro-Wilk df 32

Sig. ,008

a. Lilliefors Signif icance Correction

Des criptives GDS 49 - 72 jam

Mean 95% Conf idence Interval f or Mean


5% Trimmed Mean Median V arianc e Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis

Statistic 115,06 105,46

Std. Error 4,707

124,66 113,52 108,00 708,899 26,625 71 182 111 32 1,070 ,772

,414 ,809

Tes ts of Nor m ality a

GDS 49 - 72 jam

Kolmogorov-Smirnov Statistic df Sig. ,160 32 ,036

a. Lillief ors Signif icance Correc tion

Statistic ,906

Shapiro-Wilk df 32

Sig. ,009

83

Des criptives KOL. TOTA L

TRIGLISERIDA

HDL

LDL

Mean 95% Conf idence Interval f or Mean 5% Trimmed Mean Median V arianc e Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis Mean 95% Conf idence Interval f or Mean 5% Trimmed Mean Median V arianc e Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis Mean 95% Conf idence Interval f or Mean 5% Trimmed Mean Median V arianc e Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis Mean 95% Conf idence Interval f or Mean 5% Trimmed Mean Median V arianc e Std. Deviation Minimum Max imum Range Interquartile Range Skew nes s Kurtosis





Statistic 202,75 189,81

Std. Error 6,344

215,69 202,83 202,50 1287,742 35,885 129 280 151 44 -,034 -,110 122,13 102,73

,414 ,809 9,512

141,52 117,31 105,00 2895,145 53,807 61 273 212 48 1,492 1,850 43,81 40,82

,414 ,809 1,468

46,81 43,40 40,50 68,931 8,302 32 63 31 11 ,772 -,061 125,56 114,71

,414 ,809 5,322

136,42 124,92 122,50 906,190 30,103 79 184 105 38 ,427 -,530

,414 ,809

84

Tes ts of Normality a

KOL. TOTAL TRIGLISERIDA HDL LDL

Kolmogorov-Smirnov Statistic df Sig. ,100 32 ,200* ,189 32 ,005 ,177 32 ,012 ,140 32 ,115

Statistic ,986 ,842 ,925 ,943

Shapiro-Wilk df 32 32 32 32

Sig. ,938 ,000 ,028 ,089

*. This is a low er bound of the true signif icance. a. Lillief ors Signif icance Correction

Je nis ke lam in * Kate gori NIHSS hari 7Gabung Cr os stabulation

Jenis kelamin

Laki-laki Perempuan

Total

Count Ex pected Count Count Ex pected Count Count Ex pected Count

Kategori NIHSS hari 7Gabung Sedang+ Berat+Sangat Ringan Berat 7 12 7,1 11,9 5 8 4,9 8,1 12 20 12,0 20,0

Total 19 19,0 13 13,0 32 32,0

Chi-Square Te s ts

Pearson Chi-Square Continuity Correctiona Likelihood Ratio Fisher's Exact Test Linear-by -Linear Ass ociation N of Valid Cas es

Value ,009 b ,000 ,009

,008

df 1 1 1

1

Asy mp. Sig. (2-s ided) ,926 1,000 ,926

Exac t Sig. (2-s ided)

Exac t Sig. (1-s ided)

1,000

,607

,927

32

a. Computed only for a 2x2 table b. 1 cells (25,0%) have expec ted count less than 5. The minimum expec ted count is 4,88.

85

Riw ayat Hipe rte ns i * Kategori NIHSS hari 7Gabung Cross tabulation

Riw ayat Hipertens i + Total

Count Expected Count Count Expected Count Count Expected Count


Total 25 25,0 7 7,0 32 32,0

Chi-Square Te s ts

Pearson Chi-Square Continuity Correctiona Likelihood Ratio Fisher's Exact Test Linear-by -Linear Association N of Valid Cases

Value ,110 b ,000 ,108

df 1 1 1

,106

Asymp. Sig. (2-sided) ,740 1,000 ,742

1

Ex act Sig. (2-sided)


1,000

,535

,744

32

a. Computed only for a 2x 2 table b. 2 cells (50,0%) hav e expec ted count les s than 5. The minimum expected count is 2,63.

Dis lipide m ia * Kategori NIHSS hari 7Gabung Cros stabulation

Dislipidemia

+ -

Total



Total 25 25,0 7 7,0 32 32,0

Chi-Square Te s ts


Value 2,060b ,987 2,302

1,996

df 1 1 1

1

Asymp. Sig. (2-sided) ,151 ,320 ,129



,212

,161

,158

32


86

Me rokok * Kategori NIHSS hari 7Gabung Cros stabulation

Merokok

+


Total


Total 9 9,0 23 23,0 32 32,0

Chi-Square Te s ts


Value ,093 b ,000 ,094

df 1 1 1

,090

Asymp. Sig. (2-sided) ,761 1,000 ,760

1



1,000

,546

,764

32

a. Computed only for a 2x 2 table b. 1 cells (25,0%) hav e expec ted count les s than 5. The minimum expected count is 3,38. Infark Miokard * Kategori NIHSS hari 7Gabung Cros stabulation

Inf ark Miokard

+ -

Total



Total 9 9,0 23 23,0 32 32,0

Chi-Square Te s ts


Value 1,742b ,835 1,708

1,687

df 1 1 1

1

Asymp. Sig. (2-sided) ,187 ,361 ,191



,240

,180

,194

32


87

Kolmogorov Smirnov BMI dengan NIHSS hari ke 7 Fr eque ncies BMI

Kategori NIHSS Ringan Sedang+Berat+ Sangat Berat Total

N 12 20 32

Tes t Statis ticsa Mos t Ex treme Dif f erences

BMI ,067 ,067 ,000 ,183 1,000

A bs olute Positive Negative

Kolmogorov-Smirnov Z A sy mp. Sig. (2-tailed)

a. Grouping V ariable: Kategori NIHSS hari 7Gabung

Skor NIHSS Skor NIHSS < 48 jam c. Skor NIHSS hari ke 7 = Skor NIHSS < 48 jam d. Skor NIHSS hari ke 7 < Skor NIHSS 49 - 72 jam e. Skor NIHSS hari ke 7 > Skor NIHSS 49 - 72 jam f . Skor NIHSS hari ke 7 = Skor NIHSS 49 - 72 jam g. Skor NIHSS 49 - 72 jam < Skor NIHSS < 48 jam h. Skor NIHSS 49 - 72 jam > Skor NIHSS < 48 jam i. Skor NIHSS 49 - 72 jam = Skor NIHSS < 48 jam

Tes t Statisticsb

Z A sy mp. Sig. (2-tailed)

Skor NIHSS hari ke 7 Skor NIHSS < 48 jam -4,268a ,000

a. Based on positive ranks . b. Wilc oxon Signed Ranks Tes t

Skor NIHSS hari ke 7 Skor NIHSS 49 - 72 jam -4,089a ,000

Skor NIHSS 49 - 72 jam Skor NIHSS < 48 jam -2,392a ,017

91

20

15

10

5

0 73 81 86 92 93 97 100 103 105 107 108 113 116 119 125 127 135 140 141 157 163 168 186 194

gds_0

D_NIHSS2 30

20

10

0 Observed -10

Linear 0

100

200

300

400

GDS_0

D_NIHSS2 = selisih NIHSS 48 jam onset dengan hari ke 7 onset

92

Cas e Proces s ing Sum m ary GDS_0 Positivea Negative Mis sing

V alid N (listw ise) 3 33 1

Larger values of the tes t res ult variable(s ) indicate stronger ev idenc e f or a positive ac tual s tate. a. The positive ac tual s tate is 105.

ROC Curve 1.00

.75

.50

.25

0.00 0.00

.25

.50

.75

1.00

1 - Specificity Diagonal segments are produced by ties.

Are a Under the Cur ve Test Result V ariable(s ): D_NIHSS2

A rea .571

a

Std. Error .112

A sy mptotic b Sig. .689

A sy mptotic 95% Conf idence Interval Low er Bound Upper Bound .351 .790

The test result variable(s ): D_NIHSS2 has at least one tie betw een the positive actual state group and the negative actual state group. Statistic s may be biased. a. Under the nonparametric assumption b. Null hypothesis: true area = 0.5

93

Coordinate s of the Curve Test Res ult V ariable(s ): D_NIHSS2 Positive if Greater Than a or Equal To -1.00 .50 1.50 2.50 11.50 21.00

Sens itiv ity 1.000 1.000 .333 .000 .000 .000

1 - Specif ic ity 1.000 .667 .364 .152 .030 .000

The test result variable(s ): D_NIHSS2 has at leas t one tie betw een the pos itiv e ac tual s tate group and the negative ac tual s tate group. a. The smallest c utof f value is the minimum observ ed tes t value minus 1, and the largest cutoff value is the maximum observ ed tes t value plus 1. All the other cutof f v alues are the av erages of tw o cons ecutive ordered obs erved test values. Cor relations Spearman's rho

GDS_0

D_NIHSS1

D_NIHSS2

Correlation Coeffic ient Sig. (2-tailed) N Correlation Coeffic ient Sig. (2-tailed) N Correlation Coeffic ient Sig. (2-tailed) N

GDS_0 1.000 . 36 .176 .306 36 -.149 .386 36

**. Correlation is s ignificant at the 0.01 level (2-tailed).

Cas e Proces s ing Sum m ary GDS_0 Positivea Negative Mis sing

V alid N (listw ise) 1 35 1

Larger values of the tes t res ult variable(s ) indicate stronger ev idenc e f or a positive ac tual s tate. a. The positive ac tual s tate is 107.

D_NIHSS1 .176 .306 36 1.000 . 36 .671** .000 36

D_NIHSS2 -.149 .386 36 .671** .000 36 1.000 . 36

94

ROC Curve 1.00

.75

.50

.25

0.00 0.00

.25

.50

.75

1.00

1 - Specificity

Are a Under the Cur ve Test Result Variable(s ): D_NIHSS2

Area 1.000

a

Std. Error .000

Asy mptotic b Sig. .092

Asy mptotic 95% Conf idence Interval Low er Bound Upper Bound 1.000 1.000

a. Under the nonparametric assumption b. Null hypothesis: true area = 0.5

Coordinate s of the Curve Test Res ult V ariable(s ): D_NIHSS2 Positive if Greater Than a or Equal To -1.00 .50 1.50 2.50 11.50 21.00

Sens itiv ity 1.000 1.000 1.000 1.000 1.000 .000

1 - Specif ic ity 1.000 .686 .343 .114 .000 .000

a. The smallest c utof f value is the minimum observ ed tes t value minus 1, and the largest cutoff value is the maximum observ ed tes t value plus 1. All the other cutof f v alues are the av erages of tw o cons ecutive ordered obs erved test values.

95

Cas e Proces s ing Sum m ary V alid N (listw ise) 1 35 1

GDS_0 Positivea Negative Mis sing

Larger values of the tes t res ult variable(s) indicate stronger ev idence for a positive ac tual s tate. a. The positive actual s tate is 108.

ROC Curve 1.00

.75

.50

.25

0.00 0.00

.25

.50

.75

1.00

1 - Specificity Diagonal segments are produced by ties.

Regression V ariables Enter ed/Re m ovebd Model 1

V ariables Entered GDS_0a

V ariables Remov ed .

Method Enter

a. A ll requested variables entered. b. Dependent Variable: D_NIHSS2

Model Sum m ary Model 1

R .114 a

R Square .013

A djusted R Square -.016

a. Predictors: (Constant), GDS_0

Std. Error of the Estimate 3.321

96

ANOVAb Model 1

Regression Residual Total

Sum of Squares 4.926 375.074 380.000

df

Mean Square 4.926 11.032

1 34 35

F .447

Sig. .508 a

a. Predictors: (Constant), GDS_0 b. Dependent Variable: D_NIHSS2

Coe fficientsa

Model 1

(Constant) GDS_0

Unstandardiz ed Coef f icients B Std. Error 2.521 1.393 -.006 .010

Standardized Coef f icients Beta -.114

t 1.809 -.668

Sig. .079 .508

a. Dependent Variable: D_NIHSS2

Cut off point kadar GDS 105 mg/dl :

Kate gori NIHSS hari 7Gabung * Hiper glike m ia Cross tabulation Count

Kategori NIHSS hari 7Gabung

Ringan Sedang+Berat+ Sangat Berat

Hiperglikemia Euglikemia Hiperglikemia 7 5

Total

Nilai duga positif

= 11/20 = 55 %

Nilai duga negatif

= 7/12 = 58,3 %

Sensitivitas

= 11/16 = 68,75 %

Spesifisitas

= 7/16 = 43,75 %

Total 12

9

11

20

16

16

32

= (1-specificity) = 9/16 = 56,25 % = (1-sensitivity) = 5/16 = 3,25 % Likelihood ratio positive = 68,75 / 56,25 = 1,2 Likelihood ratio negative = 31,25 / 43,75 = 0,71