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KARYA TULIS AKHIR
UJI EFEKTIVITAS EKSTRAK DAUN BIDARA (Ziziphus mauritiana Lam)
TERHADAP KETEBALAN VENTRIKEL KIRI JANTUNG TIKUS PUTIH
(Rattus norvegicus strain wistar) MODEL HIPERTENSI
Oleh:
FIRHAN IKHYANA ZUKRUF
201510330311137
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH MALANG
2019
i
ii
iv
KATA PENGANTAR
Assalamu‟alaikum Warahmatullah Wabarakatuh
Puji syukur kehadirat Allah Subhanahu wata‟ala Yang Maha Pengasih lagi
Maha Penyayang dan atas karunia-Nya, penulisan tugas akhir ini dapat selesai
dengan baik. Shalawat serta salam selalu tercurahkan kepada Rasulullah
Muhammad shalallahu alaihi wasallam, keluarganya dan para sahabatnya yang
telah berjasa membawa syiar dakwah Islam ke seluruh dunia.
Penelitian tugas akhir ini berjudul “Uji Efektifitas Ekstrak Daun Bidara
(Ziziphus mauritiana Lam.) Terhadap Ketebalan Ventrikel Kiri Pada Tikus Putih
(Rattus Novergicus Strain Wistar) Model Hipertensi”. Tugas akhir ini diajukan
untuk memenuhi persyaratan Pendidikan Sarjana Fakultas Kedokteran Universitas
Muhammadiyah Malang.
Penulis menyadari tugas akhir ini masih jauh dari kata sempurna, oleh
karena itu, penulis sangat mengharapkan saran dan masukan yang membangun.
Semoga karya tulis ini dapat menambah wawasan keilmuan dan bermanfaat bagi
semua pihak.
Wassalamu‟alaikum Warahmatullah Wabarakatuh
Malang, 12 Mei 2019
Penulis
ix
DAFTAR ISI
LEMBAR PENGESAHAN .................................................................................. i
PERNYATAAN ORISINALITAS ....................................................................... ii
LEMBAR PENGUJIAN ....................................................................................... iii
KATA PENGANTAR ........................................................................................... iv
UCAPAN TERIMAKASIH.................................................................................. v
ABSTRAK ............................................................................................................ vii
ABSTRACT ........................................................................................................... viii
DAFTAR ISI .......................................................................................................... ix
DAFTAR TABEL ................................................................................................. xii
DAFTAR GAMBAR ............................................................................................. xiii
DAFTAR SINGKATAN ....................................................................................... xiv
BAB I PENDAHULUAN ...................................................................................... 1
1.1 Latar Belakang .......................................................................................... 1
1.2 Rumusan Masalah ..................................................................................... 3
1.3 Tujuan Penelitian ...................................................................................... 3
1.3.1 Tujuan Umum .................................................................................. 3
1.3.2 Tujuan Khusus ................................................................................. 3
1.4 Manfaat Penelitian .................................................................................... 3
1.4.1 Manfaat Ilmu Pengetahuan .............................................................. 3
1.4.2 Manfaat Klinis ................................................................................. 4
1.4.3 Manfaat bagi Masyarakat ................................................................ 4
BAB II TINJAUAN PUSTAKA ........................................................................... 5
2.1 Hipertensi .................................................................................................... 5
2.1.1 Definisi Hipertensi ........................................................................... 5
2.1.2 Klasifikasi ........................................................................................ 6
2.1.3 Epidemiologi .................................................................................... 7
2.1.4 Etiologi ............................................................................................. 7
2.1.5 Patofisiologi ..................................................................................... 9
2.1.6 Sistem Renin Angiotensin ............................................................... 11
2.1.7 Diagnosis Hipertensi ........................................................................ 12
2.1.8 Komplikasi ....................................................................................... 14
2.1.9 Tatalaksana ...................................................................................... 16
2.1.10 Kaptopril........................................................................................... 19
2.2 Jantung ........................................................................................................ 20
x
2.2.1 Anatomi Jantung .............................................................................. 20
2.2.2 Fisiologi Siklus Jantung .................................................................... 21
2.2.3 Histologi Otot Jantung ...................................................................... 23
2.2.4 Hipertrofi Ventrikel Kiri ................................................................... 24
2.3 Bidara (Zizizphus mauritiana Lam) ............................................................ 26
2.3.1 Klasifikasi ......................................................................................... 26
2.3.2 Morfologi .......................................................................................... 27
2.3.3 Kandungan ........................................................................................ 28
2.3.4 Manfaat ............................................................................................. 29
2.4 Induksi Hipertensi dengan NaCl + Prednison ............................................. 31
2.4.1 Mekanisme NaCl dalam Induksi Hipertensi ..................................... 31
2.4.2 Mekanisme Prednison dalam Induksi Hipertensi ............................. 34
2.5 Tikus ........................................................................................................... 35
2.6 Tinjauan Keislaman .................................................................................... 37
BAB III KERANGKA KONSEP DAN HIPOTESIS ......................................... 40
3.1 Kerangka Konsep Penelitian ...................................................................... 40
3.2 Hipotesis ..................................................................................................... 43
BAB IV METODOLOGI PENELITIAN ........................................................... 44
4.1 Rancangan Penelitian ................................................................................. 44
4.2 Lokasi dan Waktu Penelitian ...................................................................... 44
4.3 Populasi dan Sampel Penelitian ................................................................. 44
4.3.1 Populasi ............................................................................................. 44
4.3.2 Sampel .............................................................................................. 44
4.3.3 Estimasi Besar Sampel ...................................................................... 44
4.3.4 Karakteristik Sampel Penelitian ........................................................ 45
4.4 Variabel Penelitian dan Definisi Operasional ............................................ 46
4.4.1 Variabel ............................................................................................. 46
4.4.2 Definisi Operasional ......................................................................... 47
4.5 Bahan dan Instrumen Penelitian ................................................................. 48
4.5.1 Bahan Penelitian ............................................................................... 48
4.5.2 Instrumen Penelitian ......................................................................... 48
4.6 Alur Penelitian ............................................................................................ 50
4.7 Prosedur Penelitian ..................................................................................... 51
4.7.1 Persiapan Hewan Coba ..................................................................... 51
4.7.2 Penentuan Dosis Ekstrak Daun Bidara ............................................. 51
xi
4.7.3 Pembuatan Ekstrak Methanol Daun Bidara ...................................... 51
4.7.4 Penyiapan Dosis Penginduksi dan Kaptopril .................................... 52
4.7.5 Perlakuan Pada Kelompok Tikus ...................................................... 53
4.7.6 Proses Anestesi dan Pembuatan Sediaan Histologi .......................... 54
4.7.7 Pengamatan Hasil ............................................................................. 55
4.8 Analisis Data ............................................................................................... 55
BAB V HASIL PENELITIAN DAN ANALISIS DATA ................................... 57
5.1 Hasil Pengamatan Preparat Ventrikel Kiri Jantung .................................... 57
5.2 Uji Nomalitas Data ...................................................................................... 58
5.3 Uji Homogenitas ......................................................................................... 58
5.4 Uji One Way Anova ..................................................................................... 59
BAB VI PEMBAHASAN HASIL PENELITIAN .............................................. 60
6.1 Pembahasan ................................................................................................. 60
6.2 Keterbatasan Penelitian ............................................................................... 63
BAB VII KESIMPULAN DAN SARAN ............................................................. 64
7.1 Kesimpulan ................................................................................................. 64
7.2 Saran ............................................................................................................ 64
DAFTAR PUSTAKA ............................................................................................ 65
LAMPIRAN ........................................................................................................... 76
xii
DAFTAR TABEL
Tabel 2.1 Klasifikasi Tekanan Darah ...................................................................... 7
Tabel 2.2 Klasifikasi Tumbuhan Bidara ................................................................. 25
Tabel 2.3 Kadar Fitokima Ziziphus mauritiana ...................................................... 28
Tabel 2.4 Parameter Fisiologi Tikus Wistar Jantan Usia 4 Bulan .......................... 36
Tabel 4.1 Tabel Definisi Operasional ..................................................................... 47
Tabel 4.2 Konstanta Konversi Dosis ....................................................................... 53
Tabel 5.1 Hasil Uji One Way Anova ....................................................................... 59
xiii
DAFTAR GAMBAR
Gambar 2.1 Algoritma Diagnosis Hipertensi ......................................................... 14
Gambar 2.2 Algoritma Penanganan Hipertensi ..................................................... 18
Gambar 2.3 Anatomi Jantung ................................................................................ 21
Gambar 2.4 Histologi Otot Jantung ...................................................................... 24
Gambar 2.5 Klasifikasi dari Hipertrofi Ventrikel Kiri ........................................... 25
Gambar 2.6 Bunga, Daun dan Buah dari Zizizphus mauritiana ............................ 27
Gambar 2.7 Kandungan Flavonoid dan Fenolik Total Ekstrak Metanol,
Kloroform dan Heksana Daun Ziziphus mauritiana ......................... 29
Gambar 2.8 Mekanisme Peningkatan NaCl di sentral dan perifer ......................... 31
Gambar 2.9 Jalur Neurohormonal Hipotalamus Na+-aldosteron-EO-Angiotensi II.. 32
Gambar2.10 Mekanisme Glukokortikoid dalam menginduksi terjadinya
Hipertensi ............................................................................................. 34
Gambar 5.1 Hasil Pengamatan Tebal Ventrikel Kiri Jantung Tikus ....................... 57
Gambar 5.2 Grafik Ketebalan Otot Ventrikel Kiri Jantung Putih Jantan ............... 58
xiv
DAFTAR SINGKATAN
ACE : Angiotensin Converting Enzyme
ACE-i : Angiotensin Converting Enzyme inhibitors
ACTH : AdenoCortikoTropin Hormon
ADH : Antidiuretic Hormone
ANG II : Angiotensin II
ARBs : Angiotensin II Receptor Blocker
AT1R : Angiotensin Type 1 Receptor
CHF : Congestive Heart Failure
CNS : Central Nervous System
CSF : Cerebro Spinal Fluid
ENAC : Epithelial Na+ Channels
eNOS : endotheilial Nitric Oxide Synthase
EO : Endogeneous Ouabain
G6P : Glucose 6-Phosphate-Levels
H2O2 : Hidrogen Peroksida
HE : Hematoxilin Eosin
IDH : Isolated Diastolic Hypertension
ISH : Isolated Systolic Hypertension
L-Name : N-nitro-L-arginine-metilester
mmHg : Milimeter Air Raksa
NaCl : Natrium Klorida
NO :Nitrit Oksida
xv
NOS : Nitric Oxide Synthase
OVLT : Organosum Vaskulosum Lamina Terminalis
PVN : Paraventrikular Nucleus
RAAS : Renin Angiotensin Aldosteron System
RAS : Renin Angiotensin System
ROS : Reactive Oxygen Species
SD : Sprague-Dawley
SFO : Sub Fornikal Organ
SON : Supra Optikal Nukleus
SNA : Sympathetic Nerve Activity
SNS : Sympathetic Nervous System
LAMPIRAN
I. Analisis Data
II. Dokumentasi Kegiatan
III. Uji Taksonomi Daun Bidara
IV. Surat Etik Penelitian
V. Surat Keterangan Lolos Komisi Ilmiah
VI. Surat Keterangan Pembacaan Hasil Patologi Anatomi
VII. Surat Keterangan Telah Melakukan Penelitian
VIII. Kartu Konsultasi Tugas Akhir
IX. Hasil Deteksi Plagiasi
65
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