Supriyanto, Agus (2017) Pengaruh Pemberian Ketamin Terhadap Kadar C Reactive Protein Pada Tikus Putih (Rattus Norvegicus) Dari Galur Wistar Model Sepsis. Magister thesis, Universitas Brawijaya.
Abstract
Pendahuluan: Sepsis masih merupakan salah satu penyebab utama kematian di unit perawatan intensif. Terjadi sekitar 13 ribu pasien sepsis dengan 4 ribu kematian setiap tahun di seluruh dunia. Sepsis berat dan syok sepsis memiliki potensi tingkat kematian tinggi, hingga 46%. kematian ini terkait dengan peningkatan dramatis dari konsentrasi serum sitokin pro-inflamasi sebagai respon awal imun. C Reactive Protein (CRP) adalah protein fase akut, memiliki kontribusi untuk tuan rumah pertahanan bahwa itu adalah bagian dari respon imun bawaan. CRP juga biomarker sepsis dan reaktan fase akut yang paling luas dipelajari sejauh ini. CRP didominasi disintesis oleh hati, terutama dalam menanggapi interleukin-6 (IL-6). Sekresi CRP dimulai dalam waktu 4-6 jam dari stimulus. Ketamin juga memiliki peran dalam respon imun. itu adalah agen anestesi yang paling rasional untuk kondisi sepsis. Ketamin adalah satu-satunya anestesi intravena yang menyebabkan peningkatan tekanan arteri rata-rata tanpa mengorbankan cardiac output. studi eksperimental dan klinis telah menunjukkan bahwa ketamin diberikannya sifat antiinflamasi dengan menghambat pelepasan sitokin proinflamasi, seperti tumor necrosis factor-α (TNF-α) dan interleukin-6. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh ketamin pada kadar CRP di wistar Model tikus sepsis (Rattus novergicus). Dan untuk mengetahui perbedaan waktu dan administrasi (tunggal dan intermiten) ketamin dapat berpengaruh dalam kadar CRP. Metode: penelitian ini adalah true experimental laboratory dengan randomized Posttest Only Controlled Group Design. 30 tikus wistar jantan dengan berat 200-250 gram usia 5 bulan dibagi menjadi enam kelompok masing-masing 5 tikus. kelompok kontrol negatif tidak disuntik dengan intraperitoneal larutan fecal slury atau ketamin HCl. Larutan tinja dibuat dari tinja dikumpulkan dari sekum tikus dan dilarutkan dalam 0,9% normal fecal slurry pada konsentrasi 200 mg/ml. 25 Tikus disuntik dengan larutan fecal slurry secara intraperitoneal untuk menginduksi peritonitis (Fecal Induced Peritonitis=FIP) dan sepsis polimikroba. Kemudian, 20 tikus wistar model sepsis disuntik ketamin HCl 5 mg/kg intraperitoneal pada jam berikutnya. kelompok kontrol positif diinjeksi dengan solusi tinja saja (n = 5). Kelompok A, tikus FIP disuntik ketamin HCl 5 mg/kg pada jam ke 0 (n = 5). Kelompok B, tikus FIP disuntik dengan ketamin HCl 5 mg/kg pada jam ke 3. Kelompok C, tikus FIP disuntik dengan ketamin HCl 5 mg/kg pada jam ke 5. Grup D, tikus FIP yang ketamin HCl 5 mg/kg intermitenly padajam ke 0, 2, 4. Tanda tanda klinis dari tikus dipantau dengan Murine Sepsis Score (MSS) selama waktu penelitian. Tikus dikorbankan pada jam ke 6 setelah fecal induced Peritonitis dan darah ambil untuk diperiksa kadar CRP plasmanya. Analisis kadar CRP dilakukan dengan cara ELISA. Hasil: Pada jam ke 6 setelah peritonitis yg di induksi feses, tikus menunjukkan tanda klinis sepsis menurut MSS. Tidak ada perbedaan yang signifikan dari MSS di antara kelompok tikus FIP (p=0,094). Nilai rata-rata CRP berarti pada jam 6 setelah FIP adalah kelompok kontrol negatif 0,01 ± 0,00 mg/dl, kelompok kontrol positif 0,01 ± 0,00707 mg/dl, Kelompok A 0.012 ± 0,00837 mg/dl, kelompok B 0012 ± 0,00447 mg/dl, kelompok C 0,01 ± 0,00707 mg / dl, kelompok D 0,01 ± 0,00548 mg / dl. Perbedaan tingkat CRP x antara kelompok secara statistik tidak signifikan (p=0,536), tetapi tingkat CRP lebih tinggi pada tingkat kelompok ketamin dibanding kelompok tanpa ketamin, dan yang tertinggi adalah pada kelompok D. Kesimpulan: Perbedaan waktu dan cara (tunggal dan intermiten) injeksi ketamin tidak memberikan perbedaan yang signifikan pada kadar CRP tikus wistar Model sepsis 6 jam setelah induksi peritonitis. Tidak adanya perbedaan yang signifikan antar semua kelompok perlakuan kemungkinan karena paparan durasi sepsis pada hewan tidak mencukupi.
English Abstract
Introduction: Sepsis is still one of the major causes of death in the critically unit. it is approximately 13 thousands septic patient with 4 thousand of deaths every year worldwide. Severe Sepsis and Septic Shock have high potential mortality rates, up to 46%. This mortality is associated with dramatically increased serum concentrations of pro-inflammatory cytokines as apart of early immune response. C Reactive Protein (CRP) is acute phase protein, contributes to host defense that it is part of the innate immune response. CRP is also biomarkers of sepsis and the most extensively acute phase reactant studied so far. CRP is predominantly synthesised by the liver, mainly in response to interleukin-6 (IL-6). The secretion of CRP begins within 4–6 h of the stimulus. Ketamin also have a role in immune response. it is the most rational anesthesia agent for sepsis condition. Ketamine is the only intravenous anesthetic that causes an increase in mean arterial pressure without compromising cardiac output. Experimental and clinical studies have shown that ketamine exerts antiinflammatory properties by inhibiting the release of proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6. The purpose of the study was to determine the effect of ketamin on CRP level in the wistar rat sepsis model (Rattus Novergicus). And study the time difference and administration (single and intermittent) of ketamine can be influential in a in CRP levels. Methode: this study was a true experimental laboratory with randomized Posttest Only Controlled Group Design. 30 male wistar rats weighing 200-250 gram on age 5 month were divided into six groups of 5 rats each. control negative group was not injected with fecal solution intraperitoneal or ketamin hcl. Fecal Slurry solution was made from stool collected from the cecum of rat and it was dissolved in 0.9% normal saline at concentration 200 mg/ml. 25 Rats were injected with fecal slurry solution intraperitoneally to induce peritonitis (Fecal induced peritonitis) and polymicrobial sepsis. Then, 20 wistar rats model sepsis were injected ketamin hcl 5 mg/kg intraperitonealy at following hours (n=20). positive control group was received with fecal solutions only (n=5). A Group, FIP rats was injected ketamin hcl 5 mg/kg at 0 hours (n=5). Grup B, FIP rats were injected with ketamin hcl 5 mg/kg at 3rd hours. Group C, FIP rats were injected with ketamin hcl 5 mg/kg at 5th hours. Group D, FIP rats were ketamin hcl 5 mg/kg intermitenly at 0, 2nd , 4th hours. Clinical signs of the rats were monitored using Murine Sepsis Score (MSS) during the experimental timeline. Rats were sacrified at 6th hours after Fecal Induced Peritonitis and the bloods were harvested for the evaluation of CRP plasma. CRP analyzes were performed in the ELISA reader. Result: In 6th hour after fecal induced peritonitis, rats developed clinical sign of sepsis according to MSS. There was no statiscally difference of MSS among FIP rats groups (p=0,094). The CRP level means at 6th hour after FIP were negative Control group 0,01 ± 0,00 mg/dl, positive control group 0,01 ± 0,00707 mg/dl, A Group 0,012 ± 0,00837 mg/dl, B group 0,012 ± 0,00447 mg/dl, C group 0,01 ± 0,00707 mg/dl, D group 0,01 ± 0,00548 mg/dl. The difference of CRP level among group was not statistically significant (p=0,536), but CRP level was higher in ketamin group levels, and than the highest was in group D. Conclusion: The difference in timing and administration (single and intermittent) of ketamin injection does not provide a significant difference in CRP levels of wistar rats xii model sepsis 6 hours after induction of peritonitis. The absence of significant difference between all treatment groups is probably due to the duration of exposure sepsis in animals are insufficient.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.944/SUP/p/2017/041706293 |
| Uncontrolled Keywords: | KETAMINE, C - REACTIVE PROTEIN, SEPTICEMIA |
| Subjects: | 600 Technology (Applied sciences) > 616 Diseases > 616.9 Other disease > 616.94 Bacterial blood diseases > 616.944 Septicemia |
| Divisions: | S2/S3 > Magister Ilmu Biomedis, Fakultas Kedokteran |
| Depositing User: | Nur Cholis |
| Date Deposited: | 08 Aug 2017 03:54 |
| Last Modified: | 29 Dec 2020 05:26 |
| URI: | http://repository.ub.ac.id/id/eprint/1117 |
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