FAKTOR RISIKO YANG BERPENGARUH TERHADAP KEJADIAN STROKE NON HEMORAGIK (STUDI KASUS KONTROL PADA PASIEN RSU PROF. MARGONO SOEKARJO PURWOKERTO)

Abstract

Background :Stroke is one of community health problems. It relates to high value of morbidity, mortality, and disability. Type of stroke that is very dominant is non hemorrhagical stroke. The morbidity reports in 2001 of non-hemorrhagical stroke at Prof.Margono Soekarjo hospital reach 198 per year with Case Fatality Rate 4 — 9 °A). The aim of this research is to know the risk factors that influence to the occurrence of non hemorrhagical stroke. Method : Case-Control. Cases are the patiens of non hemorrhagical stroke who visitted Prof.Margono Soekarjo Hospital from July 2001 to October 2002. Control is the patients at inpatients service who visitted in the ward during the sometime case period. The number of the cases is 89 persons, and control is 90 persons. Data is collected from medical record, interview and measuring. Result : the results of bivariate analyse show that the all determinant variables (systolic blood pressure >= 140 mmHg, diastolic blood pressure > = 90 mmHg, content of total cholesterol > 200 mg/di, content of blood glucose level > 200 mg/dl and heart disorders) have relationship with the occurrence of non hemorrhagical stroke. The lifestyle factors that have significant relationship are body mass index, psychosocial stressor > 300 and TKE > 105 %. Waist to hip ratio, consumption of fishes < 2 time/month, consumption of meat 4 time per week, exercices, custom of smoking have no significant relationship. The result of multivariate shows that the variables which influence to the occurence of non hemorrhagical stroke are systolic blood pressure, OR = 5,52 ( CI : 2.62 — 11.60), total cholesterol > 200 mg/dl, OR = 2,15 (CI : 1,09 — 4,23) and stressor psychosocial stressor, OR = 3,29 (CI : 1,26 —8,57). Conclusions : there are three variables that influence the occurrence of non hemorrhagical stroke ( systolic blood pressure, total cholesterol and psychosocial stressor). Suggestions : it needs to control the risk factors of systolic hipertension, content of the blood cholesterol, and coping of psychosocial stressor in primary prevention. It need research for determinant factors from each variable that influence the occurence of non hemorrhagical stroke, survival analysis for the patients of non hemorrhagical stroke at Prof.Margono Soekarjo Hospital. Latar belakang : Stroke non hemoragik masih menjadi masalah kesehatan masyarakat, berkaitan dengan tingginya angka morbiditas, mortalitas dan, disabillity. Data tahun 2001 menunjukkan bahwa morbiditas stroke non hemoragik di RSU Prof Margono Soekarjo mencapai 198 orang pertahun, dengan Case Fatality Rate sebesar 4 - 9.0 %. Penelitian bertujuan untuk mengetahui faktor risiko yang berpengaruh terhadap kejadian stroke non hemoragik. Metode : Case-control. Kasus adalah pasien stroke non hemoragik yang berkunjung di RSU Prof Margono Soekarjo antara Juli 2001 hingga Oktober 2002, sedangkan kontrol adalah pasien rawat inap dari bangsal penyakit dalam dalam kurun waktu sama dengan kasus. Jumlah kasus didapat sebanyak 89 orang sedangkan kontrol sebanyak 90 orang. Data diperoleh dari catatan medis, wawancara dan pengukuran. Hasil : Analisis bivariat menunjukkan, bahwa seluruh variabel determinan yang diteliti ( tekanan darah sistolik > 140 mmHg, diastolik > 90 mmHg, kadar gula darah sewaktu > 200 mg/di, kadar kolesterol total > 200 mg/di dan kelainan jantung) berhubungan bermakna dengan kejadian stroke non hemoragik. Variabel gaya hidup yang berhubungan bermakna adalah IMT > 27, TKE >105% AKG, dan stressor psikososial > 300, sedangkan waist hip to rasio, konsumsi ikan < 2 kali/bulan, konsumsi daging >= 4 kali/minggu, oral kontrasepsi, kebiasaan olah raga, dan kebiasaan merokok, terbukti tidak berhubungan bermakna. Hasil analisis multivariate menunjukkan, variabel yang terbukti berpengaruh secara bersama-sama adalah tekanan darah sistolik OR; 5,52 (CI : 2,62 — 11,60), kolesterol total, OR ; 2,15 (CI : 1.094,23), stressor psikososial, OR ; 3,29 (CI : 1.26 - 8.57). Simpulan : Terdapat tiga variabel yang terbukti berpengaruh terhadap kejadian stroke non hemoragik, yaitu tekanan darah sistolik, kadar kolesterol total, dan stressor psikososial. Saran : Perlu adanya tindakan pengendalian faktor risiko yang berkaitan dengan hipertensi sistolik, kadar kolesterol darah, dan pengelolaan stressor psikososial dalam upaya prevensi primer. Kajian tentang determinan masing-masing variabel yang paling berpengaruh, survival analysis stroke non hemoragik, dan faktor risiko stroke non hemoragik berulang di RSU Prof Margono dapat diteliti lebih lanjut.