Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Pelvic Ring Injury: Should We Notice Acid-Base Imbalance as Mortality Predictor?

Pendahuluan. Sistem klasifikasi Young-Burgess untuk fraktur cincin pelvis terkenal karena secara teoritis merupakan klasifikasi mekanis yang mampu memprediksi mortalitas. Keuntungan itu membuat sistem klasifikasi YoungBurgess digunakan secara luas oleh dokter bedah umum dan bedah orthopaedi untuk mengarahkan terapi. Sistem klasifikasi itu juga mampu memprediksi cedera penyerta dan keparahan syok hemoragik. Hipoperfusi pada syok akan mengakibatkan asidosis metabolik, yang merupakan salah satu dari trias kematian. Bahan dan cara kerja. Rekam medis pasien cedera cincin pelvis di Departemen Orthopaedi dan Traumatologi Rumah Sakit Hasan Sadikin, Bandung sepanjang tahun 2010 dikaji secara retrospektif. Data mengenai usia, jenis kelamin, mekanisme cedera, klasifikasi Young-Burgess, base excess, kadar laktat, pH, dan keluaran dalam 24 jam diekstrak dari rekam medis tersebut. Uji Kendall-Tau digunakan untuk mencari korelasi klasifikasi Young-Burgess dengan kelas syok hemoragik, base excess, kadar laktat, pH, dan keluaran dalam 24 jam. Hasil. Terdapat korelasi signifikan antara klasifikasi Young-Burgess dengan kelas syok hemoragik (p<0,01), hemoglobin (p<0,01), pH (p<0,01), dan mortalitas (p<0,01). Terdapat korelasi signifikan antara stabilitas fraktur dengan kelas syok hemoragik (p<0,05), hemoglobin (p<0,05), pH (p<0,05), dan mortalitas (p<0,01). Simpulan. Stabilitas fraktur, keparahan syok hemoragik, dan ketidakseimbangan asam basa akan meningkatkan mortalitas. Introduction. Young-Burgess classification system for pelvic ring fracture is popular because it is theoretically a mechanistic classification that is able to predict mortality. The inherent usefulness has led to its widespread use by both orthopaedic and general surgeon in guiding treatment. It can also predict associated injuries and the severity of hemorrhagic shock. Severe hemorrhagic shock will cause hypoperfusion of tissues which may lead to metabolic acidosis, one among the triad of death. Materials and methods. Medical records of pelvic ring injury patients in Department of Orthopaedic and Traumatology Hasan Sadikin Hospital, Bandung during 2010 were retrospectively reviewed. Data about age, gender, mechanism of injury, Young-Burgess classification, base excess, lactate concentration, pH, and outcome in 24 hours were extracted. Non-parametric Kendall-Tau analysis was used to analyze the correlation among Young-Burgess classification and hemorrhagic shock class, base excess, lactate concentration, pH, and outcome in 24 hours. Kruskal-Walis test was used to determine the difference among Young-Burgess classification and hemorrhagic shock class, base excess, lactate concentration, pH, and outcome in 24 hours Results. There were significant correlation between Young-Burgess classification and severity of hemorrhagic shock (p<0.01), haemoglobin (p<0.01), pH (p<0.01), and mortality (p<0.01). There were significant correlation between stability of fracture and hemorrhagic shock class (p<0.05), haemoglobin (p<0.05), pH (p<0.05), and mortality (p<0.01). Conclusions. stability of fracture, severity of hemorrhagic shock, and acid-base imbalance will lead to higher mortality.