| dc.description.abstract | Objective: To investigate the effects of the spesific role of cardiopulmonary by pass (CPB) for increase in PAI-1 activity in type 2 Diabetes after coronary artery bypass grafting (CABG). Setting: Department of Cardiac Surgery, Intensive Care Unit, National Cardivascufar Center Harapan Kita and Laboratory Hemostasis and Thrombosis, Department Internal Medicine, National Hospital Cipto Mangunkusumo, Jakarta, Indonesia. Subjects: Three groups of subjects studied were: 10 patients with Diabetes Mellitus underwent CABG with CPB, 10 patients without OM underwent off pump coronary artery bypass (OPCAB), and 11 patients without DM underwent CABG with CPB. Intervention and measurements : The study is non-randomized experimental study. The study consists of pre-surgery, first step, second step and third step. The pre-surgery step was done to full the inclusion criteria and exclusion criteria. The first step, blood samples were taken after induction of anesthesia. Assays were carried out for PAI-1 activity, PT, APTI and level of fibrinogen. The second step, blood samples were taken after 10 minutes after protamine injection. Assays were carried out for PAI-1 activity, PT, APTI, levels of fibrinogen, hemoglobin, hematocrits, leucocytes, platelets, blood sugar, CPK and CKMB. The third step, blood samples were taken in the first day after CABG. Assays were carried out for PAI-1 activity, PT, APTT, levels of fibrinogen, hemoglobin, hematocrits, leukocytes, platelets, CPK, CKMB. Then, volume of bleeding and volume of blood transfusion were estimated after eight hour in ICU. Results: The increase in PAI-1 activity in DM patients undergoing CABG with CPB and patients without DM undergoing CABG with CPB, was found to be not significant. It looked that CPB did not aggravate the increase of PAI-1 activity in DM patients. There was a significant difference in the increase of PAI-1 activity after CPB between CABG with CPB and OPCAB in patients without DM. There was an effect of CPB in the increase of PAI-1 activity. There was an inverted significant correlation between PAI-1 activities of more than 4 U/ml and bleeding less than 300 ml after eight hours in ICU. Multiple linier regression analysis showed that blood sugar levels after protamine injection was a predictor for the increase in PAI-1 activity. PAI-1 activity was not a predictor for CPK, CKMB. The increase of PAI-1 activity in the first day after CABG was not significant between CABG with CPB and OPCAB in patients without DM. No significant difference was found in the increase in PAI-1 activity in the first day after CABG between DM patients and non-DM patients. The increase in PT, APTT after CPB were found to be not significantly different between CABG with CPB and OPCAB in patients without DM. No significant differences were found in the increase in PT.APTT after CABG between DM patients and non-DM patients. The decrease in fibrinogen levels after CPB was found to be not significantly different between CABG with CPS DM patients and CABG with CPS non-DM patients. No significant differences in the decrease in fibrinogen after CPB between DM patients and non-DM patients. No significant differences were found in the volume of bleeding in the first eight hours in the ICU between CABG with CPS and OPCAS in patients without DM. There was no significant difference in the volume of bleeding at eight hour in the ICU between CABG with CPB DM patients and CABG with CPS non-DM patients. There was significant difference in allo-tranfusion of PRC between CABG with CPS and OPCAS in patients without DM. There was significant difference in the allo-tansfusion of PRC between CABG with CPS DM patients and CABG with CPS non-DM patients. Where diabetes patients do not need to have alia-transfusion. Conclusions: There was effect of cardiopulmonary bypass in the increase of PAI-1 activity in DM patients. The increase of blood sugar is predictor for the increase of PAI-1 activity. The increase of coagulation activity was followed by the increase of PAI-1 activity; both are risk factor for thrombosis. The increase of PAI-1 activity after day one of CASG is a acute phase reaction. | en_US |
| dc.description.abstract | Tujuan : Mengujii pengaruh pintas jantung paru (PJP) terhadap peningkatan aktivitas PAI-1 pada DM tipe 2 pasca bedah pintas koroner (BPK). Tempat : Bagian Bedah Jantung , Unit Terapi Intensif Pusat Jantung Nasional Harapan Kita dan Laboratorium Hemostasis dan Trombosis Rumah Sakit Nasional Cipto Mangunkusumo, Jakarta, Indonesia. Subyek Penelitian: 10 pasien DM dengan PJP, 11 pasien non-DM dengan PJP dan 10 pasien non-DM non-PJP. Intervensi dan pengukuran : Penelitian non-randomized experimental yang terdiri dan beberapa tahap penelitian, yaitu prabedah, tahap pertama, tahap kedua, dan tahap ketiga. Tahap prabedah untuk memenuhi kriteria penerimaan dan penolakan subyek penelitian. Pada penelitian tahap pertama sampel darah diambil setelah pasien diinduksi bius dan dilakukan pemeriksaan aktivitas PAI-1, uji tapis perdarahan dan darah tepi pada DM dengan PJP, non-DM dengan PJP dan non-DM non-PJP. Pada tahap kedua sampel darah diambil pada 10 menit pasca-PJP/BPK dan dilakukan pemeriksaan aktivitas PAI-1, uji tapis perdarahan, darah tepi, kadar gula darah dan enzim jantung. Pada tahap ketiga sampel darah diambil pada hari pertama pascabedah dan dilakukan pemeriksaan aktivitas PAI-1, uji tapis perdarahan, darah tepi, enzim jantung, jumlah perdarahan 8 jam pertama di unit terapi intensif (UTI) dan jumlah darah yang ditransfusi pada DM dengan PJP, non-DM dengan PJP dan non-DM non-PJP. Hasil: Peningkatan aktivitas PAI-1 pasca-PJP tidak berbeda bermakna antara DM dengan non-DM. PJP tidak memperberat peningkatan aktivitas PAI-1 pada penderita DM. Peningkatan aktivitas PAI-1 pasca-BPKIPJP lebih tinggi pada non-DM dengan PJP daripada non-DM non-PJP. Hal ini menunjukkan adanya pengaruh PJP terhadap peningkatan aktivitas PAI-1. Didapati korelasi yang bermakna antara aktivitas PAI-1 > 4 U/ml dengan perdarahan < 300 ml pada 8 jam pertama berada di UTI. Analisis regresi ganda linier menunjukkan bahwa kadar gula darah yang tinggi merupakan prediktor terhadap peningkatan aktivitas PAl-I. Peningkatan aktivitas PAI-1 tidak merupakan prediktor terhadap CK dan CKMB. Didapati peningkatan aktivitas PAI-1 yang bermakna pada hari pertama pascabedah pada ketiga kelompok dan peningkatan aktivitas PAI-1 tersebut tidak berbeda bermakna antara non-DM dengan PJP dan non-DM non PJP juga antara DM dengan PJP dan non-DM dengan PJP. Peningkatan uji tapis perdarahan (p<0.0001) pasca-BPKIPJP pada ketiga kelompok penelitian dan peningkatan uji tapis perdarahan tersebut tidak berbeda bermakna antara non-DM dengan PJP dan non-DM non-PJP juga antara DM dengan PJP dan non-DM dengan PJP. Perdarahan pada 8 jam pertama berada di UTI tidak berbeda bermakna antara non-DM dengan PJP dan non-DM non-PJP juga antara DM dengan PJP dan non-DM dengan PJP. Allo transfusi PRe pada DM dengan PJP lebih kecil dari non-DM dengan PJP dan non-DM non-PJP lebih kecil dari non-DM dengan PJP. Kesimpulan: PJP mempunyai pengaruh terhadap peningkatan aktivitas PAI-1 pada pasien DM. Kadar gula darah yang meningkat merupakan prediktor terhadap peningkatan aktivitas PAI-1. Peningkatan aktivitas sistem koagulasi yang disertai dengan peningkatan aktivitas PAI-1 meningkatkan risiko terjadinya trombosis. Peningkatan aktivitas PAI-1 pada hari pertama pascabedah merupakan reaksi fase akut. | en_US |
