KUALITAS HIDUP ANAK PASCA SINDROM SYOK DENGUE

Abstract

Bagian Ilmu Kesehatan Anak / SMF Kesehatan Anak FK UNDIP / RS Dr. Kariadi Semarang Abstrak Latar belakang Sindrom syok dengue (SSD) merupakan manifestasi klinis berat infeksi virus dengue yang memerlukan perawatan intensif demi kelangsungan hidup penderita. Penelitian tentang kualitas hidup anak pasca SSD belum pemah dilalculcan. Tujuan : Untuk mengetahui terjadinya penurunan kualitas hidup anak pasca SSD dengan instrumen Pediatric Quality of Life Inventory (PedsQL). Rancangan penelitian : penelitian kohort berganda prospektif. Lokasi penelitian Bagian Ilmu Kesehatan Anak / SMF Kesehatan Anak FK UNDIP/RS. Dr. Kariadi (IKA FK UNDIP/RSDK) Semarang dan rumah subyek penelitian. Subyek penelitian : Penderita demam berdarah dengue (DBD) berumur 3-14 tahun yang sudah bersekolah dan tidak mempunyai ko-morbiditas yang dirawat di Bagian IKA FK UNDIP/RSDK. Analisis data : Data diolah dan dianalisis dengan program SPSS versi 10.05: Basil : Selama 24 bulan diikutkan 120 subyek, rerata umur 8,66+2,79 tahun, tidak terdapat hubungan hernial= antara umur, jenis kelamin, ras, pendidikan anak, pendapatan kelosiza, pendidikan orang tua, dan jumlah anak satu rumah (p>0,05), terdapat hubungan bermakna antara status gin (p=0,046), nilai hematokrit (p=0,022), dan jumlah trombosit (p=0,001) dengan kelompok SSD dan DBD tanpa syok. Kelompok SSD dan DBD tanpa syok semuanya mempunyai kualitas hidup normal pada 1 bulan dan 1 tahun paqoa perawatan (PedsQL > 65,48). Terdapat penurunan bermakna nilai kualitas hidup anak pasca SSD 1 bulan pasca perawatan sebesar 5,88 poin dibanding DBD tanpa syok (1=7,118; df=113,731; p=0,001; mean difference-5,887; 95% CI=-7,525 sampai -4,249). Tidak terdapat penurunan bermakna nilai kualitas hidup anak pasca SSD 1 tahun pasca perawatan (Mann-Withney U=I451,000; p=0,089). Terdapat peningkatan rerata nilai kualitas hidup anak pasca SSD secara bermakna • sebesar 8,898 poin dari 1 bulan ke 1 tahun pasca perawatan (N=59; p=0,001; correlation=0,503; mean paired sample test=-8,898; 95%C1=-10,008 sampai -7,789) yang lebih besar dibanding peningkatan pada kelompok DBD tanpa syok sebesar 4,293 poin (N=60; p=0,001; correlation=0,662; mean paired sample test=-4,293; 95%C1=-5,088 sampai -3,498). Dengan analisis regresi logistik multivariat ditemukan bahwa umur penderita, penurunan nilai Glasgow Coma Scale (GCS), penurunan rerata tekanan arteri, lama syok dan adanya penyulit mempunyai hubungan bermakna dengan terjadinya penurunan nilai kualitas hidup 1 bulan pasca perawatan (berturut-turut p=0, 021, p=0,002, p=0,008, p=0,014, dan p=0,003). Simpulan : Kualitas hidup anak pasca SSD normal, tetapi terjadi penurunan nilai kualitas hidup pada 1 bulan pasca perawatan. Umur penderita, penurunan tingkat kesadaran saat syok, penurunan rerata tekanan arteri saat syok, lama syok, dan adanya penyulit pada SSD berhubungan dengan penurunan nilai kualitas hidup 1 bulan pasca perawatan. Kata kunci : kualitas hidup, sindrom syok dengue, perawatan intensif anak. Pediatric Departement Medical Faculty Diponegoro University / Dr. Kariadi Hospital Semarang Abstract Background : Dengue Shock Syndrome (DSS) is a severe manifestation of dengue viral infection that need an intensif care nursing for the patient survival. Study on Quality of Life (QoL) meassurement in post DSS children has never been done. Objective : To identify decreasing of QoL in post DSS children with Pediatric Quality of Life Inventory (PedsQL) instrument. Design : Prospective double cohort study. Location : Pediatric Departement Medical Faculty Diponegoro University/Pediatric Ward Dr. Kariadi Hospital Semarang and home of subject study. Subject : Dengue Hemorrhagic Fever (DHF) patients without any co-morbidity age 3-14 years old who has attended school who admitted in Pediatric Departement Medical Faculty Diponegoro University/Pediatric Ward Dr. Kariadi Hospital Semarang. Data analysis : Data was processed and analyzed by SPSS version 10.05. Result : During 24 months 120 children enrolled, mean age was 8.66+2.79 years, there were no significant relationship between age, sex, race, child's education, family income, parent's education and number of children in home (p>0.05), but there was a significant relationship between nutritional status (p=0.046), level of haematocrit (p=0.022), and thrombocyte count (p=0.001) in DSS and DHF non shock groups. DSS and DHF non shock groups had a normal QoL on 1 month and 1 year follow up (PedsOL score > 65.48). There was a significant decreasing of the mean QoL score in 1 month follow up in post DSS children about 5.88 point compared with DI-IF non shock (t-7.118;df=113.731; p=0.001; mean difference-5.887; 95% CI=7.525 to –4.249). There was no significant decreasing of the mean QoL score in 1 year follow up in post DSS children (Mann-Withney U=1451.000; p=0.089). There was significant increasing of the mean QoL score in post DSS group from 1 month to 1 year follow up about 8.898 point (N=59; p=0.001; correlation=0.503; mean paired sample test=-8.898; 95%CI=- 10.008 to –7.789) that larger than DHF non shock group about 4.293 point (N=60;p=0.001; correlation=0,662; mean sample paired test=-4,239; 95%C1=-5,088 to –3,498). Multivariate regression showed significant relationships between age, decreasing of GCS, decreasing mean arterial pressure, duration of shock, and the presence of any complications in DSS with decreasing of the mean QoL score in 1 month follow up (subsequenly p=0,021, p=0,002, p=0,008, p=0,014, and p=0,003). Conclusion: Quality of life in post DSS children was normal, but there was a significant decreasing of the QoL score in 1 month follow up. Age, decreasing of level conciousness, decreasing of mean arterial pressure, duration of shock, and the presence of any complications that occured on DSS related with decreasing of the QoL score in 1 month follow up. Keywords: audio of life, dengue shock syndrome, pediatric intensif care