Hubungan fibrilasi atrial dengan tingkat keparahan stroke iskemik berdasarkan NIHSS pada pasien di Rumah Sakit Siloam Lippo Village

Wibisono, Maria Georgina (2024) Hubungan fibrilasi atrial dengan tingkat keparahan stroke iskemik berdasarkan NIHSS pada pasien di Rumah Sakit Siloam Lippo Village. Bachelor thesis, Universitas Pelita Harapan.

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Abstract

Latar Belakang: Stroke merupakan gangguan fungsi otak yang berkembang pesat dengan gejala klinis yang menetap lebih dari 24 jam. Berdasarkan RISKESDAS 2018 Kementerian Kesehatan RI, prevalensi stroke mencapai 10,9% dengan total 713.783 orang menderita stroke setiap tahunnya. Fibrilasi atrium merupakan salah satu faktor risiko utama terhadap kejadian stroke iskemik. Mekanisme utama yang menghubungkan fibrilasi atrium dengan stroke iskemik melibatkan stasis darah, cedera endotel, dan apoptosis miokardium atrium, sehingga mendorong pembentukan gumpalah darah di atrium kiri yang berkontraksi secara irregular. Setelah terbentuk, gumpalan darah tersebut dapat bermigrasi dari jantung ke otak sehingga menyebabkan penyumbatan pada pembuluh darah serebral dan memicu stroke iskemik. Penelitian yang menyelidiki korelasi antara fibrilasi atrium dan tingkat keparahan stroke iskemik memberikan hasil yang tidak konsisten. Oleh karena itu, penelitian lebih lanjut diperlukan untuk menjelaskan hubungan antara fibrilasi atrium dan tingkat keparahan stroke iskemik. Tujuan Penelitian: Mengetahui hubungan antara fibrilasi atrial dengan tingkat keparahan stroke iskemik berdasarakan NIHSS pada pasien di Rumah Sakit Siloam Lippo Village. Metode Penelitian: Penelitian ini menggunakan studi observasional dengan studi retrospective cohort dan metode analitik komparatif kategorik tidak berpasangan pada 55 sampel yang akan dipilih dengan cara nonprobabilitas secara pencuplikan purposive. Data yang diperoleh akan diolah menggunakan SPSS Statistics dan dianalisis menggunakan metode chi-square. Variabel yang bermakna akan dianalisis lebih lanjut dengan analisis multivariat logistik. Hasil Analisis Data: Terdapat hubungan yang signifikan antara fibrilasi atrial dengan tingkat keparahan stroke iskemik berdasarkan NIHSS pada pasien di Rumah Sakit Siloam Lippo Village Gedung A dan B dengan nilai p-value sebesar 0,004 pada uji Continuity Correction Chi Square dan nilai p-value sebesar 0,001 dan OR 4,499 (95% CI = 1,836 – 11,025) pada uji multivariat. Melalui uji multivariat, dapat disimpulkan bahwa faktor lain seperti riwayat hipertensi (p-value = 0,039, OR 2,802), dan riwayat penyakit jantung koroner (p-value = 0,038, OR 2,690) mempunyai hubungan yang signifikan dan dapat mempengaruhi tingkat keparahan stroke iskemik berdasarkan NIHSS. / Background: Stroke is a rapidly developing disorder of brain function with clinical symptoms that persist for more than 24 hours. According to RISKESDAS 2018 conducted by the Indonesian Ministry of Health, the prevalence of stroke reached 10.9% with a total of 713,783 individuals suffering from stroke annually. Atrial fibrillation emerges as a key risk factor for ischemic stroke. The primary mechanism linking atrial fibrillation to ischemic stroke involves blood stasis, endothelial injury, and apoptosis of atrium myocardium, thus promoting the formation of blood clots in the irregularly contracting left atrium. Once formed, these blood clots can migrate from the heart to the brain, causing blockages in cerebral blood vessels and triggering ischemic stroke. Studies investigating the correlation between atrial fibrillation and the severity of ischemic stroke yield inconsistent results. Thus, further research is required to elucidate the correlation between atrial fibrillation and the severity of ischemic stroke. Objective: To determine the relationship between atrial fibrillation and the severity of ischemic stroke based on NIHSS in patients at Siloam Lippo Village Hospital. Methodology: This study employs an observational approach, incorporating a retrospective cohort design and an unpaired categorical comparative analytical approach applied to 55 samples, selected through non-probability purposive sampling. The collected data will undergo processing using SPSS Statistics and will be subjected to analysis using the chi-square method. Variables deemed significant will undergo further analysis through logistic multivariate analysis. Data Analysis Results: There is a significant relationship between atrial fibrillation and the severity of ischemic stroke based on the NIHSS in patients at Siloam Lippo Village Hospital Buildings A and B with a p-value of 0,004 in the Continuity Correction Chi Square test and a p-value of 0,001 and OR 4,499 (95% CI = 1,836 – 11,025) in the multivariate test. Through multivariate testing, it can be concluded that other factors such as history of hypertension (p-value = 0,039, OR 2,802), and history of coronary heart disease (p-value = 0,038, OR 2,690) have a significant relationship and can influence the severity of ischemic stroke based on NIHSS.

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