SKRIPSI

RIZKA IRMANIA DEVANTI

STUDI PENGGUNAAN SITIKOLIN PADA

PASIEN STROKE ISKEMIK

(Penelitian Dilakukan di Rumah Sakit Umum Daerah Sidoarjo)

PROGRAM STUDI FARMASI

FAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH MALANG

2017

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KATA PENGANTAR

Alhamdulillahirrobbil’alamin, puji dan syukur penulis panjatkan kepada

Allah SWT atas segala rahmat, nikmat serta pertolongan-Nya sehingga penulis

dapat menyelesaikan skripsi ini yang berjudul STUDI PENGGUNAAN

SITIKOLIN PADA PASIEN STROKE ISKEMIK (Penelitian Dilakukan di

Rumah Sakit Umum Daerah Sidoarjo).

Skripsi ini diajukan untuk memenuhi syarat untuk mencapai gelar Sarjana

Farmasi pada Program Studi Farmasi Fakultas Ilmu Kesehatan Universitas

Muhammadiyah Malang. Dalam penyusunan skripsi ini penulis tidak terlepas dari

peranan beberapa pembimbing dan juga bantuan dari seluruh pihak. Oleh karena

itu, dengan segala kerendahan hati, penulis ingin mengucapkan terima kasih

kepada:

1. Allah SWT yang telah memberikan kesehatan dan juga kelancaran dalam

menyelesaikan skripsi ini.

2. Bapak Yoyok Bekti Prasetyo, S.Kep., M.Kep., Sp.Kom. selaku Dekan

Fakultas Ilmu Kesehatan Universitas Muhammadiyah Malang.

3. Direktur RSUD Sidoarjo yang telah mengizinkan penulis untuk melakukan

penelitian di RSUD Sidoarjo.

4. Staf pegawai Diglit dan Rekam Medik yang telah banyak membantu

pelaksanaan penelitian di RSUD Sidoarjo.

5. Ibu Nailis Syifa’, S.Farm., M.Sc., Apt. selaku pembimbing I, yang telah

meluangkan waktunya untuk membimbing, mengarahkan, memberi

masukan serta semangat kepada penulis, sampai selesainya skripsi ini.

6. Bapak Drs. Didik Hasmono, MS., Apt. selaku dosen pembimbing II yang

telah banyak membantu dan memberi dorongan serta ide kepada penulis

dalam menyelesaikan skripsi ini.

7. Ibu Hidajah Rachmawati, S.Si., Apt., Sp.FRS. dan ibu Dra. Lilik

Yusetyani, Apt., Sp.FRS. selaku dosen Penguji yang telah banyak

memberikan saran dan masukan serta motivasi demi kesempurnaan skripsi

ini.

8. Untuk seluruh dosen, laboran, dan staf tata usaha Program Studi Farmasi

Fakultas Ilmu Kesehatan Universitas Muhammadiyah Malang.

9. Untuk kedua orang tua tercinta, yang setiap hari selalu mengingatkan

untuk tak lupa berdoa dan belajar. Yang selalu mendukung setiap hal baik

yang penulis lakukan. Terima kasih banyak untuk doa-doa yang tak henti

dipanjatkan oleh beliau hingga akhirnya berhasil menjadi sarjana farmasi.

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10. Kakak-kakakku tersayang, Azril Yanuar Hidayaturahman, Nuril Nuritza

Meinandya, Ayub Wirasukma yang telah membantu, mendo’akan, serta

turut memberikan semangat yang tiada hentinya.

11. Untuk Rizky Alvian Adi Kurniawan, berkat dorongan dan semangatnya

penulis dapat menyelesaikan skripsi ini tepat waktu.

12. Teman-temanku Genk Rumpik, Lintang, Chiko, Naniek, Cici, Ripho,

Lilik. Karena kalian hari-hari penulis di Farmasi UMM tidak

membosankan dan menyenangkan.

13. Teman-temanku SMA, Ejjeng, Yaya, Azmi, Tika, Dayana, Lely,

Samantha, Ifa, yang selalu ada setiap penulis butuh kalian.

14. Teman-teman satu tema skripsi, Manggi, Anita, Naniek, Dede, Terima

kasih sudah menjadi teman diskusi, teman berdebat, teman penelitian, dan

teman ujian. Sukses ya!

15. Seluruh teman-teman farmasi angkatan 2013 yang telah berjuang bersama

penulis untuk menyelesaikan pendidikan di Program Studi Farmasi UMM.

Semoga doa dan amal baik semua pihak tersebut mendapatkan imbalan

dari Allah SWT. Penulis menyadari bahwa skripsi ini sangat jauh dari

kesempurnaan, oleh karena itu penulis mengharapkan saran dan kritik yang

membangun dari pembaca. Semoga penulisan skripsi ini dapat berguna bagi

penelitian berikutnya dan bagi siapapun yang membacanya.

Wassalamu’alaikum warohmatullohi wabarokatuh

Malang, 7 Juni 2017

Rizka Irmania Devanti

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DAFTAR ISI

LEMBAR PENGESAHAN .................................................................................. ii

LEMBAR PENGUJIAN ...................................................................................... iii

KATA PENGANTAR .......................................................................................... iv

RINGKASAN ....................................................................................................... vi

ABSTRAK .......................................................................................................... viii

ABSTRACT .......................................................................................................... ix

DAFTAR ISI ...........................................................................................................x

DAFTAR GAMBAR .......................................................................................... xiii

DAFTAR TABEL .............................................................................................. xiv

DAFTAR LAMPIRAN ........................................................................................xv

BAB I PENDAHULUAN .......................................................................................1

1.1 Latar Belakang ......................................................................................... 1

1.2 Rumusan Masalah .................................................................................... 3

1.3 Tujuan Penelitian ...................................................................................... 4

1.3.1 Tujuan Umum ..................................................................................4

1.3.2 Tujuan Khusus.................................................................................4

1.4 Manfaat Penelitian .................................................................................... 4

BAB II TINJAUAN PUSTAKA ...........................................................................5

2.1 Anatomi Otak ........................................................................................... 5

2.2 Definisi Stroke .......................................................................................... 6

2.3 Epidemiologi stroke ................................................................................. 7

2.4 Klasifikasi Stroke ..................................................................................... 8

2.4.1 Stroke Iskemik......................................................................................9

2.4.2 Stroke Hemoragik...............................................................................11

2.5 Patofisiologi Stroke Iskemik .................................................................. 12

2.6 Faktor Resiko Stroke .............................................................................. 15

2.7 Tanda dan Gejala Stroke ........................................................................ 18

2.8 Pemeriksaan Penunjang .......................................................................... 18

2.9 Penatalaksanaan Stroke .......................................................................... 19

2.10 Terapi Khusus Stroke Iskemik ............................................................... 20

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2.10.1 Terapi Trombolitik...............................................................................20

2.10.2 Terapi Anti Platelet...........................................................................20

2.10.3 Terapi Neuroprotektan........................................................................21

2.10.4 Terapi Antikoagulan...........................................................................22

2.10.5 Terapi Anti Hipertensi........................................................................23

2.10.6 Terapi Dislipidemia...........................................................................24

2.11 Terapi Neuroprotektan Pada Stroke Iskemik ......................................... 25

2.11 Terapi Sitikolin Pada Stroke Iskemik ..................................................... 27

2.12 Evidence Based Medicine ...................................................................... 31

BAB III KERANGKA KONSEPTUAL .............................................................34

BAB IV METODE PENELITIAN .....................................................................37

4.1 Rancangan Penelitian ............................................................................. 37

4.2 Populasi dan Sampel .............................................................................. 37

4.2.1 Populasi..........................................................................................37

4.2.2 Sampel............................................................................................37

4.3 Kriteria Data ........................................................................................... 37

4.3.1 Kriteria Data Inklusi.......................................................................37

4.3.2 Kriteria Data Eksklusi ....................................................................37

4.4 Bahan Penelitian ..................................................................................... 38

4.5 Instrumen Penelitian ............................................................................... 38

4.6 Lokasi dan Waktu Penelitian .................................................................. 38

4.7 Prosedur Pengumpulan Data .................................................................. 38

4.8 Metode Pengumpulan Data .................................................................... 38

4.9 Analisa Data ........................................................................................... 39

4.10 Definisi Operasional ............................................................................... 39

BAB V HASIL PENELITIAN ............................................................................41

5.1 Data Demografi Pasien ........................................................................... 42

5.1.1 Jenis Kelamin.................................................................................42

5.1.2 Usia Pasien.....................................................................................42

5.1.3 Status Pasien...................................................................................42

5.2 Faktor Resiko Pasien dengan Diagnosis Stroke Iskemik ....................... 43

5.3 Klasifikasi Stroke Iskemik ..................................................................... 43

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5.4 Penggunaan Sitikolin Pada Pasien Stroke Iskemik ................................ 44

5.4.1 Pola Penggunaan Terapi Sitikolin..................................................44

5.4.2 Profil Penggunaan Terapi Tunggal Sitikolin..................................44

5.4.3 Profil Penggunaan Sitikolin dengan Kombinasi............................45

5.4.4 Profil Penggunaan Sitikolin dengan Pola Switch Obat..................45

5.5 Distribusi dan Pola Terapi Pada Pasien Stroke Iskemik ........................ 46

5.6 Lama Penggunaan Sitikolin Pada Pasien Stroke Iskemik ...................... 47

5.7 Lama Masuk Rumah Sakit (MRS) Pasien Stroke Iskemik .................... 48

5.8 Kondisi Keluar Rumah Sakit (KRS) Pasien Stroke Iskemik.................. 48

BAB VI PEMBAHASAN.....................................................................................49

BAB VII KESIMPULAN DAN SARAN ............................................................60

7.1 Kesimpulan ............................................................................................. 60

7.2 Saran ....................................................................................................... 60

DAFTAR PUSTAKA ...........................................................................................61

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DAFTAR GAMBAR

Gambar 2.1 Anatomi otak manusia.........................................................................5

Gambar 2.2 Perbedaan bentuk stroke......................................................................8

Gambar 2.3 Klasifikasi stroke.................................................................................9

Gambar 2.4 Mekanisme terbentuknya plak aterosklerosis....................................11

Gambar 2.5 Patofisiologi stroke iskemik...............................................................13

Gambar 2.6 Struktur Kimia Sitikolin.....................................................................27

Gambar 2.7 Jalur cytidine-5-diphoshocholine dari sintesis enzimatik

fosfatidikolin..........................................................................................................27

Gambar 2.8 Mekanisme kerja sitikolin..................................................................28

Gambar 3.1 Skema Kerangka Konseptual.............................................................35

Gambar 3.2 Skema Kerangka Oprasional..............................................................36

Gambar 5.1 Skema Penelitian Kriteria Inklusi dan Eksklusi pada Pasien Stroke

Iskemik...................................................................................................................41

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DAFTAR TABEL

Tabel II.1 Epidemiologi Stroke Berdasarkan Ras atau Etnis.................................17

Tabel II.2 Perbandingan Farmakokinetik Obat Neuroprotektan............................26

Tabel II.3 Farmakokinetik Sitikolin.......................................................................31

Tabel V.1 Jenis Kelamin Pasien Stroke Iskemik...................................................42

Tabel V.2 Usia Pasien Stroke Iskemik...................................................................42

Tabel V.3 Status Pasien Stroke Iskemik................................................................43

Tabel V.4 Faktor Resiko Pasien Stroke Iskemik...................................................43

Tabel V.5 Klasifikasi Stroke Iskemik....................................................................43

Tabel V.6 Pola Penggunaan Terapi Sitikolin.........................................................44

Tabel V.7 Pola Penggunaan Terapi Tunggal Sitikolin...........................................44

Tabel V.8 Profil Penggunaan Sitikolin dengan Kombinasi...................................45

Tabel V.9 Profil Penggunaan Sitikolin dengan Pola Switch Obat.........................45

Tabel V.10 Distribusi dan Pola Terapi Pada Pasien Stroke Iskemik.....................46

Tabel V.11 Lama Penggunaan Sitikolin Pada Pasien Stroke Iskemik...................47

Tabel V.12 Lama Masuk Rumah Sakit (MRS) Pasien Stroke Iskemik.................48

Tabel V.13 Kondisi Keluar Rumah Sakit (KRS) Pasien Stroke Iskemik..............48

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DAFTAR LAMPIRAN

Lampiran 1 Daftar Riwayat Hidup.........................................................................69

Lampiran 2 Surat Pernyataan.................................................................................70

Lampiran 3 Surat Pengantar Bakesbangpol Sidoarjo.............................................71

Lampiran 4 Nota Dinas RSUD Sidoarjo................................................................72

Lampiran 5 Ethical Clearance...............................................................................73

Lampiran 6 Daftar Nilai Normal Data Klinik dan Data Laboratorium..................74

Lampiran 7 Lembar Pengumpulan Data................................................................76

Lampiran 8 Tabel Data Induk................................................................................79

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