skripsi - eprints.umm.ac.ideprints.umm.ac.id/48309/1/pendahuluan.pdf · iv kata pengantar...

i

SKRIPSI

MUHAMAD ANDRIYANTO FIRDAUS

STUDI PENGGUNAAN SEFOTAKSIM PADA

PASIEN SIROSIS HATI DENGAN SBP

(Spontaneous Bacterial Peritonitis)

(Penelitian Dilakukan di RSUD Dr.Saiful Anwar Malang)

PROGRAM STUDI FARMASI

FAKULTAS ILMU KESEHATAN

UNIVERSITAS MUHAMMADIYAH MALANG

2019

iv

KATA PENGANTAR

Assalamualaikum Wr. Wb.

Segala puji syukur penulis panjatkan kehadirat Allah SWT yang telah

melimpahkan berkah dan nikmat ke hamba-Nya, karena dengan pertolongan-Nya

skripsi yang berjudul Studi Penggunaan Sefotaksim Pada Pasien Sirosis Hati

Dengan SBP (Spontaneous Bacterial Peritonitis) (Penelitian dilakukan di

Rumah Sakit Umum Dr.Saiful Anwar Malang) dapat diselesaikan tepat waktu

dan dengan sebaik-baiknya.

Selanjutnya perkenankanlah penulis mengucapkan terima kasih yang tidak

terhingga kepada:

1. Bapak Drs. Didik Hasmono, M.S.,Apt selaku pembimbing I yang telah banyak

meluangkan waktu untuk membimbing dan memberi masukan ilmu, motivasi,

serta menginspirasi penulis selama menempuh pendidikan sampai

terselesaikannya tugas akhir ini.

2. Ibu Dr., Dra. Lilik Yusetyani, Apt., Sp.FRS. selaku Pembimbing II yang

selalu sabar dalam membimbing serta mengarahkan dan tidak sedikit

mengorbankan waktu untuk membimbing hingga tugas akhir ini dapat

diselesaikan dengan baik dan tepat waktu.

3. Ibu Ika Ratna Hidayati, S.Farm., M.Sc., Apt dan Ibu Firasti Agung M.S.,

M.Biotech., Apt selaku penguji I dan II yang telah memberikan masukan dan

saran untuk perbaikan tugas akhir ini.

4. Bapak Faqih Ruhyanudin M.Kep., Sp. Kep.MB selaku Dekan Fakultas Ilmu

Kesehatan Universitas Muhammadiyah Malang.

5. Ibu Dian Ermawati, M.Farm, Apt selaku Ketua Progam Studi Farmasi

Universitas Muhammadiyah Malang.

6. Direktur dan staf Rumah Sakit Umum Dr. Saiful Anwar Malang yang telah

membantu kelancaran penilitian skripsi.

7. Orang tua Ibu Sri Lestari dan Bapak Mohammad Ma’sum yang selalu

memberikan doa serta dorongan moril maupun materil yang tak terhingga.

x

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

DAFTAR SINGKATAN ................................................................................. xvi

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

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

1.2 Rumusan Masalah .................................................................................. 4

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

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

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

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

1.4.1 Bagi Peneliti ..........................................................................................4

1.4.2 Bagi Rumah Sakit ...................................................................................4

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

2.1 Hati........................................................................................................ 5

2.1.1 Anatomi dan Strukstur Hati ...................................................................5

2.1.2 Sirkulasi Hati ..........................................................................................7

2.1.3 Fungsi Hati ..............................................................................................8

2.2 Sirosis Hati .......................................................................................... 11

2.2.1 Definisi .................................................................................................. 11

xi

2.2.2 Epidemiologi ......................................................................................... 11

2.2.3 Etiologi .................................................................................................. 12

2.2.4 Patofisiologi .......................................................................................... 12

2.2.5 Manifestasi Klinis ................................................................................. 13

2.2.6 Data Laboratorium ............................................................................... 14

2.2.7 Komplikasi ............................................................................................ 19

2.2.8 Managemen Penatalaksanaan Sirosis Hati ......................................... 23

2.2.9 Penatalaksanaan Komplikasi Pada Sirosis Hati ................................. 24

2.3 SBP (Spontaneous Bacetrial Peritonitis) .............................................. 27

2.3.1 Definisi .................................................................................................. 27

2.3.2 Epidemiologi ......................................................................................... 27

2.3.3 Etiologi .................................................................................................. 28

2.3.4 Faktor Resiko ........................................................................................ 29

2.3.5 Patofisiologi SBP.................................................................................. 29

2.3.6 Diagnosa Klinis .................................................................................... 31

2.3.7 Penatalaksanaan SBP ........................................................................... 32

2.4 Tinjauan Tentang Sefotaksim ............................................................... 41

2.4.1 Mekanisme Kerja Sefotaksim .............................................................. 42

2.4.2 Sifat Farmakodinamik Dan Farmakokinetik Sefotaksim ................... 42

2.4.3 Penggunaan Terapetik Sefotaksim pada SBP ..................................... 43

BAB III KERANGKA KONSEPTUAL........................................................... 46

3.1 Kerangka Konseptual ........................................................................... 46

3.2 Kerangka Operasional .......................................................................... 47

BAB IV METODE PENELITIAN ................................................................... 48

4.1 Rancangan Penelitian ........................................................................... 48

4.2 Populasi dan Sampel ............................................................................ 48

4.3 Bahan Penelitian .................................................................................. 49

4.4 Instrumen Penelitian ............................................................................ 49

4.5 Tempat dan waktu penelitian ............................................................... 49

4.6 Definisi Operasional ............................................................................ 49

4.7 Metode Pengumpulan Data ................................................................. 50

4.8 Analisa Data ........................................................................................ 51

xii

BAB V HASIL PENELITIAN ........................................................................ 52

5.1 Data Demografi Pasien ........................................................................ 53

5.1.1 Distribusi Berdasarkan Jenis Kelamin ................................................. 53

5.1.1 Distribusi Berdasarkan Usia ................................................................. 53

5.1.3 Distribusi Berdasarkan Status Pasien................................................... 54

5.2 Komplikasi .......................................................................................... 54

5.3 Profil Terapi Lainnya ........................................................................... 55

5.4 Pola Penggunaan Sefotaksim Pada Pasien Sirosis Hati Dengan SBP .... 55

5.4.1 Pola Penggunaan Terapi Sefotaksim .................................................. 55

5.3.2 Pola Penggunaan Terapi Sefotaksim Tunggal.................................... 56

5.3.3 Pola Penggunaan Terapi Sefotaksim Kombinasi ............................... 56

5.3.5 Lama Penggunaan Terapi Sefotaksim ................................................ 57

5.4 Lama Rawat Inap Pasien Sirosis Hati Dengan SBP .............................. 58

5.6 Kondisi Keluar Rumah Sakit (KRS) Pasien Sirosis Hati Dengan SBP .. 58

BAB VI PEMBAHASAN ................................................................................. 59

BAB VII KESIMPULAN DAN SARAN ......................................................... 76

7.1Kesimpulan ............................................................................................... 76

DAFTAR PUSTAKA ....................................................................................... 77

LAMPIRAN ..................................................................................................... 86

xiii

DAFTAR GAMBAR

Gambar Halaman

2. 1 Anatomi Hati. ......................................................................................... 5

2. 2 Hati Normal Dan Cedera Hati Kronis ..................................................... 6

2. 3 Aliran vena porta & Pasokan arteri ke hati .............................................. 7

2. 4 Patofisiologi sirosis hati........................................................................ 13

2. 5 Manifestasi klinis sirosis hati ................................................................ 14

2. 6 Patofisiologi asites................................................................................ 21

2. 7 Patofisiologi SBP. ............................................................................... 29

2. 8 Indikasi Antibiotik Profilaksis Pada Sirosis…………………................ 39

2. 9 Struktur Kimia Sefotaksim.……………………………………………..41

3. 1 Skema Kerangka konseptual…..…………………….......…………….. 46

3. 2 Skema Kerangka Operasional..……………………….......…………….47

5. 1 Skema sampel yang memenuhi kriteria inklusi dan eksklusi………….. 52

xiv

DAFTAR TABEL

Tabel Halaman

II. 1 Etiologi sirosis hati ................................................................................ 12

II. 2 Nilai normal pemerikasaan laboratorium ............................................... 18

II. 3 Managemen Terhadap Etiologi Sirosis Hati. ......................................... 24

II. 4 Bakteri penyebab SBP .......................................................................... 28

II. 5 Rejimen antibiotik yang direkomendasikan untuk mengobati SBP ........ 33

II. 6 Antibiotik Sefalosporin ......................................................................... 37

II. 7 Daftar nama obat sefotaksim di Indonesia ............................................. 45

V. 1 Distribusi berdasarkan jenis kelamin........................................................53

V. 2 Distribusi berdasarkan usia .................................................................... 53

V. 3 Distribusi berdasarkan status pasien ....................................................... 54

V. 4 Komplikasi penyerta pada pasien SBP ................................................... 54

V. 5 Terapi lainnya pada pasien SBP ............................................................. 55

V. 6 Pola penggunaan terapi sefotaksim pada pasien SBP ............................. 55

V. 7 Pola penggunaan terapi sefotaksim tunggal pada pasien SBP ................. 56

V. 8 Pola terapi sefotaksim kombinasi pada pasien SBP ................................ 56

V. 9 Pola switch sefotaksim pada pasien SBP ................................................ 57

V. 10 Lama penggunaan terapi sefotaksim pada pasien SBP ........................... 57

V. 11 Lama perawatan pada pasien SBP.......................................................... 58

V. 12 Pola penggunaan terapi sefotaksim pada pasien SBP ............................. 58

xv

DAFTAR LAMPIRAN

Lampiran Halaman

1 Daftar Riwayat Hidup ....................................................................... 86

2 Surat Pernyataan ............................................................................... 87

3 Surat Ijin Penelitian .......................................................................... 88

4 Surat Laik Etik ................................................................................. 89

5 Lembar Pengumpulan Data .............................................................. 90

6 Tabel Data Induk ............................................................................ 184

77

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