PENGARUH TERAPI HIPERBARIK OKSIGEN TERHADAP PASIEN OSTEOMIELITIS 2, PEMBIMBNG DR. HISNINDARSYAH, DR....

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BAGIAN ILMU KESEHATAN MASYARAKAT

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

REFERAT

JUNI 2016

TERAPI OKSIGEN HIPERBARIK PADA PASIEN OSTEOMIELITIS

Pembimbin !

Le"#$% L&'" (K) *+, Hi-nin*&+-.&/ SE, M,Ke-,

Le""' L&'" (K) *+, An*i#& A'-

Di-'-'n O%e/!

1. Tri Rahmawati (2009-!-00"#

2. $ai%&''i% S. Ha'ia)&tra (2009-!-009#

!. A*ma+i' (2009-!-019#

DIBAAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

PADA BAGIAN ILMU KESEHATAN MASYARAKAT

RSAL D+, F, SUHARDJO

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

AMBON

2016

0



TERAPI OKSIGEN HIPERBARIK PADA PASIEN OSTEOMIELITIS

A. Ot,mi,*iti

a. P,%'ah&*&a%

Pen.&#i" in3e#-i &*&%&/ -&%&/ -&"' 4en.&#i" .&n m&-i/ -e+in "e+5&*i *i

*'ni&, S&%&/ -&"' 4en.&#i" in3e#-i .&n menen&i "'%&n &*&%&/ $-"e$mie%i"i-,

O-"e$mie%i"i- me+'4&#&n -'&"' 4+$-e- 4e+&*&n&n 4&*& "'%&n .&n

*i-eb&b#&n $%e/ in&-i mi#+$$+&ni-me (b&#"e+i *&n 5&m'+),

Di ne&+&7ne&+& be+#emb&n $-"e$mie%i"i- m&-i/ me+'4&#&n m&-&%&/

*&%&m bi*&n $+"/$4e*i,

Di In*$ne-i& $-"e$mie%i"i- m&-i/ me+'4&#&n m&-&%&/ #&+en& "in#&"

/iieni- .&n m&-i/ +en*&/ *i&n$-i- .&n "e+%&mb&" &n#& #e5&*i&n

"'be+#'%$-i- .&n m&-i/ "ini 4en$b&"&n $-"e$mie%i"i- meme+%'#&n 8&#"'

%&m& *&n bi&.& .&n "ini -e+"& b&n.&# 4&-ien *en&n 3+&#"'+ "e+b'#& .&n

*&"&n "e+%&mb&" *&n -'*&/ men5&*i $-"e$mie%i"i-,

O-"e$mie%i"i- *&4&" menen&i "'%&n7"'%&n 4&n5&n e+"eb+&"'%&n

4e%i- "'%&n "en#$+&# *&n m&n*ib'%&, Mi#+$$+&ni-me bi-& men9&4&i

"'%&n *&n -en*i b&i# me%&%'i "+&'m& %&n-'n 4&*& #'%i" mi-&%n.& &#ib&"

"'-'#&n #e9i% %'#& b&9$# %&-e+&-i 3+&#"'+ "e+b'#& &"&' #&+en& $4e+&-i &"&'

-e9&+& "i*&# %&n-'n me%&%'i &%i+&n *&+&/ *&+i b&i&n %&in mi-&%n.& /i*'n

&"&' m'%'" "+&#"'- +e-4i+&"$+i'- '-'- &"&' "+&#"'- eni"$'+in&+i'-,

In-i*en-i $-"e$m.e%i"i- be+#i-&+ &n"&+& 01:1;< *&+i 4$4'%&-i $+&n

*e8&-&, P+e&%en-in.& 4&*& &n&#7&n&# be+'-i& #'+&n *&+i 1 "&/'n &*&%&/ 1

#&-'- 4e+ 1000 4$4'%&-i -e*&n#&n 4&*& &n&#7&n&# .&n %ebi/ "'& &*&%&/ 1

#&-'- *&+i =000 4$4'%&-i, P+e&%en-i $-"e$m.e%i"i- #+$ni# be+#i-&+ &n"&+& =7

2=< *&+i #&-'- $-"e$m.e%i"i- &#'",

M$+"&%i"&- $-"e$m.e%i"i- "e+5&*i -e#i"&+ =72=< *&n &*& 4'%& .&n

me%&4$+#&n /in& >0< 4&*& e+& -ebe%'m &n"ibi$"i# *i"em'#&n, Se#&+&n

1



m$+"&%i"&- "e%&/ men9&4&i &n#& 0<, Se*&n#&n m$+bi*i"&- men9&4&i &n#&

=< men5&*i #$m4%i#&-i, K$m4%i#&-in.& &n"&+& %&in &*&%&/ &+"/+i"i- -e4"i#

#e+'-&#&n 5&+in&n %'n&# -e#i"&+ #e&n&-&n &mi%$i*$-i- -e#'n*e+ *&n

3+&#"'+ 4&"$%$i-,

. D,/i%ii

O-"em$mie%i"i- &*&%&/ -'&"' 4+$-e- in3%&m&-i &#'" m&'4'n #+$ni# 4&*&

"'%&n *&n -"+'#"'+ *i-e#i"&+n.& .&n *i-eb&b#&n $%e/ $+&ni-me 4.$eni#,

D&%&m #e4'-"&#&&n %&in *in.&"&#&n b&/8& $-"e$mie%i"i- &*&%&/ +&*&n "'%&n

.&n *i-eb&b#&n $%e/ $+&ni-me 4i$eni# 8&%&'4'n be+b&&i &en in3e#-i

%&in 5'& *&4&" men.eb&b#&nn.&, Ini *&4&" "e"&4 "e+%$#&%i-&-i &"&' *&4&"

"e+-eb&+ me%&%'i "'%&n me%ib&"#&n -'m-'m #$+"e#- 5&+in&n #&n-e%$-& *&n

4e+i$-"e'm, (D$+%&n* 2002), Be+&-&% *&+i #&"& $-"e$n ("'%&n) *&n m.e%$

(-'m-'m "'%&n) *i&b'n#&n *en&n i"i- (4e+&*&n&n) .&n *i*e3ini-i#&n

-eb&&i #e&*&&n #%ini- *im&n& "'%&n "e+in3e#-i $%e/ mi#+$$+&ni-me, D&%&m

"i& 4'%'/ "&/'n "e+&#/i+ 4&"$ene-i- 4en.&#i" ini /&m4i+ *&4&" *i#%&+i3i#&-i

*&n b&n.&# 3&#"$+ .&n "e%&/ *ii*en"i3i#&-i menen&i in3e#-i "e+-eb'",

. K*ai/iai

O-"e$mie%i"i- -e9&+& 'm'm *&4&" *ib&i men5&*i 5eni- 4i$eni# *&n

n$n4i$eni#, N&m'n "e+*&4&" 5eni- 4en#%&-i3i#&-i&n %&inn.& -e4e+"i

be+*&-&+#&n 4e+5&%&n&n #%ini- .&i"' $-"e$mie%i"i- &#'" &"&' #+$ni- (&#"i3 *&n

"i*&# &#"i3) .&n "e+&n"'n in"en-i"&- *&+i 4+$-e- in3e#-i *&n e5&%& .&n

"e+#&i", D&+i -'*'" 4&n*&n 4&"$%$i &n&"$mi $-"e$mie%i"i- *&4&" *ib&i

men5&*i $-"e$mie%i"i- ben"'# diffuse *&n %$#&% (3$9&%) *en&n .&n #e*'&

*i-eb'" -eb&&i &b-e- "'%&n, K&"e$+i #e"i& *&%&m #%&-i3i#&-i ini &*&%&/

$-"e$mie%i"i- .&n "imb'% #&+en& in-'3i-ien-i &-#'%&+,

O-"e$mie%i"i- A#'" Bi&-&n.& *i-e+"&i *en&n e5&%& -e4"i#emi& -e4e+"i

2



3eb+i- m&%&i-e *&n &n$+e#-i&, In3e#-i *&4&" 4e9&/ #e -'b4e+i$-"e'm

#em'*i&n menemb'- -'b#'"i- *&n men.eb&+ men5&*i -e%'%i"i- &"&' men5&%&+

me%&%'i +$n& -'b4e+i$-"e'm #e *i&3i-i-, In3e#-i 5'& *&4&" 4e9&/ #e b&i&n

"'%&n *i&3i-i- me%&%'i #&n&%i- me*'%&+i-, Pen5&%&+&n -'b4e+i$-"e&% #e &+&/

*i&3i-i- &#&n me+'-&# 4emb'%'/ *&+&/ .&n #e *i&3i-i- -e/in&

men.eb&b#&n ne#+$-i- "'%&n .&n *i-eb'" -e#'e-"e+, Pe+i$-"e'm &#&n

memben"'# "'%&n b&+' .&n men.e%'b'ni "'%&n m&"i "e+-eb'", T'%&n b&+'

.&n men.e%im'"i "'%&n m&"i "e+-eb'" *in&m&#&n in$%'#+'m, Pe+'b&/&n

5&+in&n %'n&# *&4&" "e+5&*i -e9&+& n.&"& "e+'"&m& 4&*& b&.i, Pemben#&#&n

*en&n e*em& *&n "imb'n&n %em&# .&n #&b'+ *&4&" "e+%i/&", O-"e$4$+$-i-

*&4&" *i%i/&" &n"&+& /&+i #e-e4'%'/ -&m4&i em4&" be%&- *&+i $n-e" "imb'%n.&

4en.&#i", P&*& &n&#7&n&# -e+in#&%i "e+5&*i 4&*& me"&3i-i-, In$%'9+'m *&4&"

"e+%i/&" -e"e%&/ "i& min' *&n "e+5&*i %ebi/ b&n.&# 4&*& b&.i *&n &n&#7&n&#

*&+i4&*& $+&n *e8&-&, Tem4&" #e%'&+n.& *&n *e#$m4+e-i 4'- .&n "e+5&*i

*&4&" men9e&/ #$m4+e-i &-#'%e+ *&n "e+5&*in.& in3&+# *&n 4en.emb'/&n,

Peme+i#-&&n ?T .&n #$nen-i$n&% "i*&# *&4&" men*e"e#-i -e#'e-"e+,

Se#'e-"e+ "e+%i/&" -eb&&i 3+&men73+&men *&+i "'%&n 4&*&" *i&n"&+& 4+$-e-

*e-"+'#-i "'%&n %$#&%, Pen$b&"&n *en&n &n"ibi$"i# *&n@&"&' 4embe*&/&n

membe+i 4en&+'/ 4&*& 4e+5&%&n&n 4en.&#i"n.& *en&n 4emben"'#&n "'%&n

b&+' .&n *&4&" *i"em'#&n, Den&n "e+&4i .&n &*e#'&" 4&*& b&.i *&n &n&#7

&n&# /&+&4&n 'n"'# #emb&%i n$+m&% be-&+ #e9'&%i "e+5&*i #e+'-&#&n 4&*&

%em4en e4i3i-i- *&n e4i3i-i- -e/in& 4e+"'mb'/&n "'%&n .&n &bn$+m&%

*&4&" "e+5&*i, P&*& $+&n *e8&-& 4en&+'/n.& "'%&n -e+in men.i-&#&n

*&e+&/ -#%e+$"i# *&n ben"'# .&n i+e'%e+, G&mb&+&n +&*i$+&3i "i*&# 4e+n&/

bi-& #emb&%i n$+m&% 4&*& #&-'- .&n "e+%&mb&" *i#e"&/'i,

O-"e$mie%i"i- K+$ni- memi%i#i 9i+i #/&- 4&n5&nn.& e5&%& #%ini- 4e+i$*e

*i&m ('ie-9en9e) .&n 4&n5&n *&n e#-&-e+b&-i be+'%&n, S&%'+&n -in'-



&n"&+& "'%&n *&n #'%i" *&4&" men/&-i%#&n m&"e+i&% .&n 4'+'%en" *&n

#&*&n7#&*&n memb'&" 4$"$n&n74$"$n&n "'%&n .&n ne#+$"i#,

Penin#&"&n 4+$*'#-i m&"e+i&% .&n 4'+'%en" n.e+i &"&' ben#&# -eb&&i

"&n*& -'&"' e#-&-e+b&-i *i-e+"&i *en&n 4enin#&"&n #&*&+ C reactive protein

(?RP) *&n ESR, Dem&m 5&+&n "e+5&*i #e9'&%i bi%& $b-"+'#-i *&+i -&%'+&n

-in'- men.eb&b#&n in3e#-i 5&+in&n %'n&#, K$m4%i#&-i &#/i+ .&n 5&+&n

i&%&/ 3+&#"'+ 4&"$%$i- #&+-in$m& -e% -#'&m$-& 4&*& -&%'+&n -in'- *&n

&mi%$i*$-i-,

K%&-i3i#&-i %&in .&n bi&-& *i'n&#&n *i&mb&+#&n $%e/ ?ie+n. *##,

Si-"em ini *i#en&% -eb&&i #%&-i3i#&-i ?ie+n.7M&*e+ me%i4'"i > -"&*i'm

&n&"$mi!

1, S"&*i'm 1 &"&' me*'%&+i $-"e$mie%i"i- /&n.& "e+b&"&- 4&*& +$n& me*'%&

"'%&n, O-"e$mie%i"i- /em&"$en *&n &*&n.& in3e#-i 4&*& in"+&me*'%%&

&*&%&/ 9$n"$/ -"&*i'm ini,

2, S"&*i'm 2 &"&' -'4e+3i-i&% $-"e$mie%i"i- /&n.& me%ib&"#&n "'%&n #$+"i#&%

*&n bi&-&n.& be+&-&% *&+i in$#'%&-i %&n-'n &"&' 3$#'- in3e#-i .&n

be+*e#&"&n,

, S"&*i'm &"&' %$#&% $-"e$mie%i"i- bi&-&n.& me%ib&"#&n b&i&n #$+"i#&%

*&n me*'%& *&+i "'%&n, N&m'n *&%&m "&/&4 ini "'%&n m&-i/ -"&bi%

#&+en& 4+$-e- in3e#-i "i*&# me%ib&"#&n -e%'+'/ *i&me"e+ "'%&n,

>, S"&*i'm > &"&' *i3'- $-"e$mie%i"i- me%ib&"#&n -e%'+'/ #e"eb&%&n "'%&n

*en&n /i%&nn.& -"&bi%i"&-,

Den&n -i-"em ini 4&-ien *en&n $-"e$mie%i"i- *i#%&-i3i#&-i#&n -eb&&i

/$-" A B &"&' ?, P&*& /$-" A "i*&# memi%i#i 3&#"$+ #$m4+$mi- -i-"emi# &"&'

%$#&% /$-" B *i4en&+'/i $%e/ -&"' &"&' %ebi/ 3&#"$+ #$m4+$mi- *&n /$-" ?

*i4en&+'/i $%e/ 3&#"$+ #$m4+$mi-e .&n b&n.&# -e/in& *i4e+%'#&n

4en$b&"&n +&*i#&% .&n memi%i#i +&-i$ +i-i#$ "ini (T&be% I),

>



!" An&#7&n&# ('-i& > b'%&n -&m4&i > "&/'n)! Streptococcus $ dan

, &aemophilus influen'ae, dan Entero!acter"

c" Rem&5& ('-i& > "&/'n -&m4&i *e8&-&)! S" aureus (80%), elompo

Streptococcus $, & influen'ae, *&n Entero!acter

d" De8&-&! S" aureus *&n #&*&n7#&*&n Entero!acter *&n

Streptococcus,

2, O-"e$mie%i"i- %&n-'n

'm'mn.& *i-eb&b#&n $%e/ S, A'+e'- -4e-ie- en"e+$b&9"e+ *&n -4e-ie-

4-e'*$m$n&-, T'-'#&n me%&%'i -e4&+"' &"%e"i# ! -, &'+e'- *&n -4e-ie-

4-e'*$m$n&-, Pen.&#i" -e% -&bi" ! -"&4/.%$9$99'- *&n -&%m$ne%%&,

,. E)i',mi*i

E4i*emi$%$i $-"e$mie%i"i- memi%i#i bebe+&4& #e9en*e+'n&n .&n

%'&-, In-i*en $-"e$mie%i"i- /em&"$en "&m4&#n.& men'+'n, D&%&m -eb'&/

4ene%i"i&n *i G%&-$8 S#$"%&n*i& *&+i 2= #&-'- $-"e$mie%i"i- /em&"$en

&#'" 4&*& &n&# *i b&8&/ 1 "&/'n "e+*&4&" %&4$+&n 4en'+'n&n #e5&*i&n *&+i

; -&m4&i >2 4e+ 10,000 4e+ "&/'n -e%&m& 4e+i$*e 20 "&/'n 4en.e%i*i#&n,

J'm%&/ #&-'- $-"e$mie%i"i- .&n me%ib&"#&n "'%&n 4&n5&n men'+'n

-emen"&+& 4&*& -'mbe+ %&in "in#&" $-"e$mie%i"i- "e"&4 -&m&, P+e&%en-i

in3e#-i Staphylococcus aureus 5'& men'+'n *&+i ==< men5&*i 1< -e%&m&

4e+i$*e 20 "&/'n, Be+be*& *en&n $-"e$mie%i"i- /em&"$en #e5&*i&n

$-"e$mie%i"i- #&+en& in$#'%&-i %&n-'n &"&' 3$#'- in3e#-i .&n be+*e#&"&n

menin#&",

H&% ini m'n#in &#ib&" #e9e%&#&&n #en*&+&&n be+m$"$+ *&n

menin#&"n.& 5'm%&/ 4en'n&&n 4e+&n#&" 3i#-&-i $+"$4e*i *&n im4%&n

-en*i, L&#i7%&#i memi%i#i "in#&" .&n %ebi/ "ini *&+i 4&*& 4e+em4'&n 4&*&

$-"e$mie%i"i- $%e/ #&+en& in3e#-i 3$#'- .&n be+*e#&"&n, P&*& &#/i+n.&

$-"e$mie%i"i- "e+5&*i *en&n 3+e#'en-i .&n %ebi/ "ini 4&*& 4&-ien

imm'n$9$m4+$mi-e,

6



Tin#&" m$+"&%i"&- +en*&/ #e9'&%i .&n be+/'b'n&n *en&n -e4-i-

&"&' #ebe+&*&&n #$n*i-i me*i- be+&" .&n men*&-&+i, Ti*&# &*& 4enin#&"&n

#e5&*i&n $-"e$mie%i"i- *i9&"&" be+*&-&+#&n +&-, P+i& memi%i#i +e-i#$ +e%&"i3

%ebi/ "ini .&n menin#&"#&n me%&%'i m&-& #&n&#7#&n&# mem'n9&# 4&*&

m&-& +em&5& *&n 5&"'/ #e +&-i$ +en*&/ 4&*& $+&n *e8&-&,

Se9&+& 'm'm $-"e$mie%i"i- memi%i#i *i-"+ib'-i '-i& bim$*&%,

O-"e$mie%i"i- &#'" /em&"$en$'- me+'4&#&n -'&"' 4en.&#i" 4+ime+ 4&*&

&n&#, T+&'m& %&n-'n *&n 3$#'- $-"e$mie%i"i- be+*e#&"&n %ebi/ -e+in

"e+5&*i 4&*& $+&n *e8&-& *&n +em&5& *&+i 4&*& &n&#, O-"e$mie%i"i- e+"eb+&%

%ebi/ -e+in 4&*& $+&n "'& *&+i >= "&/'n,

/. Pat,%,i

In3e#-i *&4&" "e+5&*i -e9&+& ! 1, Hem&"$en *&+i 3$#'- .&n 5&'/

-e4e+"i #'%i" "en$+$#, 2, K$n"&min&-i *&+i %'&+ .&i"' 3+&#"'+ "e+b'#& *&n

"in*&#&n $4e+&-i 4&*& "'%&n , Pe+%'&-&n in3e#-i 5&+in&n #e "'%&n *i

*e#&"n.&,

Mi#+$$+&ni-me mem&-'#i "'%&n bi-& *en&n 9&+& 4en.eb&+%'&-&n

-e9&+& /em&"$en bi-& -e9&+& 4en.eb&+&n *&+i 3$#'- .&n be+*e#&"&n *en&n

in3e#-i &"&' #&+en& %'#& 4ene"+&-i, T+&'m& i-#emi& *&n ben*& &-in

menin#&"#&n #e+en"&n&n "'%&n &#&n "e+5&*in.& in&-i mi#+$b& 4&*& %$#&-i

.&n "e+b'#& ("e+e#-4$-) .&n *&4&" meni#&" b&#"e+i *&n men/&mb&"

4e+"&/&n&n /$-", F&$-i" men9$b& 'n"'# men&n&ni in3e#-i *&n *&%&m

4+$-e-n.& enCim *i%e4&-#&n -e/in& me%i-i-#&n "'%&n, B&#"e+i me%&+i#&n

*i+i *&+i 4e+"&/&n&n /$-" *en&n menem4e% #'&" 4&*& "'%&n .&n +'-&#

*en&n mem&-'#i *&n be+"&/&n *&%&m $-"e$b%&-" *&n *en&n me%&4i-i "'b'/

*&n %&4i-&n .&n men*&-&+i "'b'/ me+e#& -en*i+i *en&n 4e%in*'n bi$3i%m

.&n #&.& 4$%i-&#&+i*&, N&n&/ men.eb&+ #e *&%&m -&%'+&n 4emb'%'/ *&+&/



menin#&"#&n "e#&n&n in"+&$--e$'- *&n mem4en&+'/i &%i+&n *&+&/,

Di-eb&b#&n in3e#-i .&n "i*&# *i$b&"i -e/in& men5&*i #+$ni-

ne#+$-i- i-#emi# "'%&n men/&-i%#&n 4emi-&/&n 3+&men *e&-#'%&+i-&-i

.&n be-&+ (-e'e-"e+), Ke"i#& n&n&/ menemb'- #$+"e#- -'b4e+i$-"e&% &"&'

memben"'# &b-e- 4&*& 5&+in&n %'n&# *&n 4enin#&"&n 4e+i$-"e'm &#&n

men'm4'# "'%&n b&+' (in$%'9+'m) -e#i"&+ -e'e-"e+, Mi#+$$+&ni-me

in3i%"+&-i ne'"+$3i% *&n #$ne-"i &"&' "e+-'mb&"n.& 4emb'%'/ *&+&/

me+'4&#&n "em'&n /i-"$%$i- '"&m& $-"e$mie%i"i- &#'", Fi"'+ .&n

membe*&#&n *&+i $-"e$mie%i"i- #+$ni- .&i"' "'%&n .&n ne#+$-i- *i9i+i#&n

$%e/ "i*&# &*&n.& $-"e$-i" .&n /i*'4, Te+*&4&" -e% m$n$n'#%e&+ .&n

*$min&n 4&*& in3e#-i #+$ni- *&n +&n'%&-i *&n 5&+in&n 3ib+$-&

men&n"i#&n "'%&n .&n "e%&/ *i-e+&4 #emb&%i $%e/ $-"e$#%&-, P&*& "&/&4

#+$ni- $+&ni-me m'n#in "e+%&%' -e*i#i" 'n"'# *i%i/&" 4&*& 4e8&+n&&n,

G&mb&+ 1, O-"e$mie%i"i- &#'", (&) in3e#-i 4&*& me"&3i-i- (b) bebe+&4& *&+i "'%&n

.&n m&"i "e+%e4&- *&n memben"'# -eb'&/ -e'e-"+'m (9) 4emben"'#&n

in$%'9+'m .&n &#&n men&%&mi 4e+3$+&-i -in'-, -'mbe+! A4%e.- -.-"em $3

$+"/$4&e*i9- &n* 3+&9"'+e-,2010,

T&be% 2, O-"e$mie%i"i- /em&"$en 4&*& #&-'- .&n "i*&# *i$b&"i

;



O-"e$m.e%i"i- -e+in men.e+"&i 4en.&#i" %&in -e4e+"i *i&be"e- me%i"'-

sicel cell disease, #*S, + dru a!use, aloholism 4en'n&&n -"e+$i*

.&n be+#e4&n5&n&n imm'n$-'44+e-&n *&n 4en.&#i" -en*i .&n #+$ni#,

Pem&#&i&n 4+$-"/e"i9 &*&%&/ -&%&/ -&"' 3&#"$+ +e-i#$ bei"' 5'& *en&n

4embe*&/&n $+"$4e*i *&n 3+&#"'+ "e+b'#&,

. Dia%i

Manifestasi klinik

An&#7&n&# *en&n $-"e$mie%i"i- /em&"$en memi%i#i "&n*&7"&n*& in3e#-i

&#'" "e+m&-'# *em&m i+i"&bi%i"&- %e"&+i *&n "&n*&7"&n*& 4e+&*&n&n %$#&%,

N&m'n *&%&m -eb'&/ -"'*i 4&*& 6; &n&# =0< *&+i memi%i#i e5&%& .&n

-&m&+ "e+m&-'# n.e+i 4&*& "'n#&i &n"&+& *'+&-i 1 -&m4&i b'%&n *&4&"

*i-e+"&i 4enin#&"&n -'/', An&#7&n&# *en&n $-"e$mie%i"i- /em&"$en

bi&-&n.& memi%i#i 5&+in&n %'n&# .&n "i*&# "e+in3e#-i .&n memb'n#'-

"'%&n .&n "e+in3e#-i *&n m&m4' membe+i#&n +e-4$n 4e+"&/&n&n e3e#"i3

"e+/&*&4 in3e#-i, Sen*i bi&-&n.& "e+/in*&+ *&+i in3e#-i #e9'&%i -'*&/ "e+5&*i

me"&3i-i- *iin"+&9&4-'%&+ -e4e+"i .&n *i"em'#&n *i b&i&n 4+$#-im&% *&+i



#e #i+i bi&-&n.& *i-e+"&i *en&n 4enin#&"&n 5'm%&/ %e'#$-i"

4$%im$+3$n'#%e&+, Tin#&" ?7+e&#"i3 4+$"ein bi&-&n.& "ini *&n n$n-4e-i3i#

4ene%i"i&n ini m'n#in %ebi/ be+'n& *&+i4&*& %&5' en*&4&n *&+&/ (LED)

#&+en& men'n5'#&n &*&n.& 4enin#&"&n LED 4&*& 4e+m'%&&n, LED bi&-&n.&

menin#&" (0<) n&m'n "em'&n ini -e9&+& #%ini- "i*&# -4e-i3i#, ?RP *&n

LED memi%i#i 4e+&n "e+b&"&- *&%&m menen"'#&n $-"e$mie%i"i- #+$ni-

-e+in#&%i *i*&4&"#&n /&-i% .&n n$+m&%,

Se5'm%&/ "e- %&b$+&"$+i'm .&n be+be*& /&+'- *i%&#'#&n 4&*& 4&-ien

*en&n $-"e$mie%i"i- 'n"'# mem&n"&' "$#-i-i"&- $b&" ("in#&" #+e&"inin -e+'m

*&n "e- 3'n-i /&"i) -"&"'- iCi (#&*&+ -e+'m &%b'min *&n total iron-!indin

capacity) *&n #$m$+bi*i"&- (mi-&%n.& #&*&+ %'#$-& *&+&/ 'n"'# 4&-ien

*en&n *i&be"e-),

Kultur

Di&n$-i- *&n 4enen"'&n e"i$%$i $-"e$mie%i"i- 4&*& "'%&n 4&n5&n

"e+&n"'n 4&*& i-$%&-i 4&"$en *&%&m #'%"'+ -4e-imen *&+i %e-i "'%&n *&+&/

&"&' 9&i+&n -en*i, P&*& 4&-ien *en&n ?ie+n.7M&*e+ : -"&*i'm 1 &"&'

/em&"$en $-"e$mie%i"i- #'%"'+ *&+i *&+&/ &"&' 9&i+&n -en*i .&n 4$-i"i3

*&4&" "i*&# *i%&#'#&n #e"i#& 4&*& +&*i$+&3i "e+b'#"i $-"e$mie%i"i-, Ke9'&%i

$-"e$mie%i"i- /em&"$en .&n 4&*& #'%"'+ *&+&/ &"&' 9&i+&n -en*i m'n#in

*&4&" *i%&#'#&n *&n bi%& 4$-i"i3 4en$b&"&n &n"ibi$"i# $-"e$mie%i"i- /&+'-

*i*&-&+#&n 4&*& -"'*i -en-i"ii"&- *&+i #'%"'+ "'%&n *i&mbi% 4&*& -&&"

*eb+i*emen" &"&' *&%&m bi$4-i "'%&n, Ji#& mem'n#in#&n #'%"'+ -4e-imen

/&+'- *i4e+$%e/ -ebe%'m &n"ibi$"i# *im'%&i, N&m'n -e9&+& em4i+i-

4embe+i&n &n"ibi$"i *im'%&i -ebe%'m #'%"'+ -4e-imen *i4e+$%e/, D&%&m /&%

ini +e5imen em4i+i# /&+'- *i/en"i#&n -e%&m& "i& /&+i -ebe%'m 4en&mbi%&n

-&m4e% 'n"'# #'%"'+, K'%"'+ -4e-imen *&+i -&%'+&n -in'- "i*&# *&4&"

11



*i&n*&%#&n 'n"'# mem4+e*i#-i $+&ni-me .&n &#&n *ii-$%&-i *&+i "'%&n

.&n "e+in3e#-i, N&m'n #$+e%&-i 4$-i"i3 "e%&/ *i"em'#&n &n"&+& 4e+"'mb'/&n

Staphylococcus aureus 4&*& #'%"'+ -4e-imen *&+i -&%'+&n -in'- *&n 4&*&

#'%"'+ "'%&n,

Te#ni# mi#+$bi$%$i #$nen-i$n&% bi&-&n.& *i'n&#&n 'n"'# *i&n$-i-

$-"e$mie%i"i-, N&m'n bebe+&4& 4en'%i- "e%&/ mene"&4#&n b&/8&

menin#&"#&n "e#ni# 'n"'# 4en$%&/&n b&/&n 4'+'%en *&4&" men/&-i%#&n

4e+-en"&-e .&n %ebi/ "ini *&+i -"+&in- .&n "e+i-$%&-i, Te#ni# lisis-

sentrifuasi "e%&/ *i5e%&-#&n 'n"'# menin#&"#&n -en-i"ii"&- 4&*& -&m4%e

#'%"'+ $-"e$mie%i"i-, Polymerase chain reaction *i#en&% -eb&&i "e#ni#

&m4%i3i#&-i en "e%&/ *i'n&#&n *&%&m *i&n$-i- in3e#-i "'%&n 4&*& 4&"$en

.&n -'%i" -e4e+"i -e4e+"i ycoplasma pneumoniae .rucella -4e-ie-

.artonella henselae *&n -4e-ie- yco!acterium TB *&n n$n"'be+9'%$'-,

Polymerase chain reaction "e%&/ men*e"e#-i M.9$b&9"e+i'm "'be+9'%$-i- *i

formaldehida solution-fi/ed -&m4e% 5&+in&n74&+&3in .&n &*& 4&*& 4&-ien

*en&n Pott disease,

Pencitraan

Bebe+&4& 4en9i"+&&n .&n bi&- *i'n&#&n 'n"'# $-"e$mi.e%i"i- .&i"' !

1, R&*i$+&3i

B'#"i +&*i$+&3i *&+i $-"e$mie%i"i- &#'" 4e+"&m& #&%i *i'-'%#&n $%e/ &*&n.&

e*em& 5&+in&n %'n&# 4&*& 7= /&+i -e"e%&/ "e+in3e#-i, Pe+'b&/&n "'%&n "i*&#

"e+%i/&" 'n"'# 1>721 /&+i *&n 4&*& &8&%n.& be+m&ni3e-"&-i -eb&&i e%e&-i

4e+i$-"e&% *ii#'"i $%e/ %'9en9ie- #$+"i#&% &"&' me*'%e+, Den&n 2; /&+i 0<

4&-ien men'n5'##&n bebe+&4& #e%&in&n, Se#i"&+ >07=0< #e/i%&n&n 3$#'-

"'%&n .&n men.eb&b#&n "e+*e"e#-in.& %'9en9. 4&*& 3i%m bi&-&,

2, MRI

Pen9i"+&&n +e-$n&n-i m&ne"i# "e%&/ *i&#'i -eb&&i m$*&%i"&- be+'n& 'n"'#

12



men*i&n$-& #ebe+&*&&n *&n in3e#-i m'-#'%$-#e%e"&%, Re-$%'-i 4en9i"+&&n

+e-$n&n-i m&ne"i# be+'n& 'n"'# membe*&#&n &n"&+& "'%&n *&n in3e#-i

5&+in&n %'n&# .&n -e+in men5&*i m&-&%&/ *en&n men'n&#&n

+&*i$n'#%i*&, Sen-i"ii"&- be+#i-&+ &n"&+& 07100<,

, R&*i$n'#%i*& -9&nnin "'%&n

Ti& 3&-e -9&n "'%&n -9&n &%%i'm *&n -9&n -e% *&+&/ 4'"i/ men5&*i

4e+"imb&n&n 4&*& 4&-ien .&n "i*&# m&m4' me%&#'#&n 4en9i"+&&n MRI,

Seb'&/ 3&-e "i& -9&n "'%&n memi%i#i -en-i"ii"&- .&n "ini *&n -4e-i3i-i"&-

4&*& $+&n *e8&-& *en&n "em'&n n$+m&% 4&*& +&*i$+&3, S4e-i3i-i"&- -e9&+&

*+&m&"i- men'+'n *&%&m 4en&"'+&n $4e+&-i -ebe%'mn.& &"&' "+&'m& "'%&n,

D&%&m #e&*&&n #/'-'- in3$+m&-i "&mb&/&n *&4&" *i4e+$%e/ *&+i

4emin*&i&n %ebi/ %&n5'" *en&n %e'#$-i" be+%&be% *en&n 6 &%%i'm *&n @

&"&' in*i'm 111, P&*& 99m-technetium polifosfat -9&n men*em$n-"+&-i#&n

4enin#&"&n &#'m'%&-i i-$"$4 *i bi*&n 4enin#&"&n &%i+&n *&+&/ *&n 3$+m&-i

+e&#"i3 4&*& "'%&n b&+', Scan technetium-99m m'n#in ne&"i3 'n"'# 4&-ien

*en&n $-"e$mie%i"i- #&+en& "e+5&*i 4en'+'n&n &%i+&n *&+&/ #e &+e& .&n

"e+in3e#-i

>, ?T -9&n

?T -9&n &#-i&% m'n#in mem&in#&n 4e+&n *&%&m *i&n$-i- $-"e$mie%i"i-,

Penin#&"&n #e4&*&"&n "'%&n -'m-'m "e+5&*i *i &8&% 4e+5&%&n&n in3e#-i *&n

&- in"+&me*'%%& "e%&/ *i%&4$+#&n 4&*& 4&-ien *en&n $-"e$mie%i"i-

/em&"$en, Computed tomoraphy *&4&" memb&n"' meni*en"i3i#&-i#&n

"'%&n .&n ne#+$"i# *&n men'n5'#&n #e"e+%ib&"&n 5&+in&n %'n&# -e#i"&+n.&,

S&%&/ -&"' #e'n"'n&n *&+i ini &*&%&/ &*&n.& scatter phenomenon .&n /&*i+

#e"i#& &mb&+&n %$&m m'n9'% *i*&%&m &"&' *e#&" "'%&n .&n "e+in3e#-i *&n

men/&-i%#&n #e/i%&n&n +e-$%'-i &mb&+,

=, U%"+&-$n$+&3i

1



Te#ni# -e*e+/&n& *&n m'+&/ "e%&/ men5&n5i#&n "e+'"&m& 4&*& &n&#

*en&n $-"e$mie%i"i- &#'", U%"+&-$n$+&3i *&4&" men'n5'##&n 4e+'b&/&n

-e5&# 172 /&+i -e"e%&/ "imb'%n.& e5&%&, Ke%&in&n "e+m&-'# &b-e- 5&+in&n

%'n&# &"&' #'m4'%&n 9&i+&n *&n e%e&-i 4e+i$-"e&%, Ti*&#

mem'n#in#&n 'n"'# e&%'&-i #$+"e#- "'%&n,

6, T,ra)i

Pen$b&"&n .&n "e4&" 'n"'# $-"e$mie%i"i- me%i4'"i *+&in&-e .&n

mem&*&i *eb+i*emen" men.e%'+'/ $b%i"e+&-i +'&n m&"i 4e+%in*'n&n %'#&

*&n 9&#'4&n &n"imi#+$b& -4e-i3i#, Ji#& 4&-ien &*&%&/ host .&n #$m4+$mi-e

4e+%' *i%&#'#&n '4&.& 'n"'# mem4e+b&i#i &"&' men'+&ni *e3e# 4&*& host ,

Pe+/&"i&n -e9&+& #/'-'- *ibe+i#&n 'n"'# n'"+i-i 4+$+&m be+/en"i me+$#$#

*&n 4enen*&%i&n 4en.&#i" "e+"en"' -e4e+"i *i&be"e-, Den&n *emi#i&n

*i%&#'#&n '-&/& 'n"'# menin#&"#&n -"&"'- #e-e/&"&n iCi *&n 4emb'%'/

*&+&/ *&+i 4&-ien 'n"'# men*&4&"#&n 4e+&8&"&n .&n $4"im&% *&+i 4en.&#i"

.&n men*&-&+i &4&4'n, I*e&%n.& -"&n*&+ 4e+&8&"&n me%ib&"#&n 4en*e#&"&n

"im "e+m&-'# -4e-i&%i- 4en.&#i" men'%&+ *$#"e+ be*&/ 4%&-"i# *&n *$#"e+

#$n-'%"&-i %&inn.& .&n -e-'&i,

Pengobatan Antibiotik

B&n.&# &-4e# 4en$b&"&n &n"ibi$"i# $-"e$mie%i"i- be%'m -e4en'/n.&

*i-e%i*i#i, Bi&-&n.& *'+&-i 4en$b&"&n *i -eb&i&n be-&+ "&/&4&n

$-"e$m.e%i"i- (?ie+n.7M&*e+ T&/&4&n 1 *&n >) &*&%&/ > -&m4&i 6 min',

A%&-&n 'n"'# *'+&-i ini *i*&-&+#&n 4&*& /&-i% -"'*i 4&*& /e8&n *&n

4en&m&"&n b&/8& +e&-#'%&+i-&-i "'%&n -e"e%&/ *eb+i*emen" mem&#&n

8&#"' -e#i"&+ em4&" min', Pen'n&&n &n"ibi$"i# in"+&en& &"&' $+&% (6

b'%&n &"&' %ebi/) "e%&/ *i9$b& $%e/ bebe+&4& 4ene%i"i "e"&4i /&-i% *&+i '5i 9$b&

"e+-eb'" membe+i#&n 4e+b&i#&n .&n #'+&n be+m&#n& *ib&n*in#&n *en&n

1>



me+e#& .&n meni#'"i 6 min' "e+&4i, Ke&&%&n "e+5&*i 4&*& -em'& '5i

#%ini- be+&4&4'n m&-& 4en$b&"&nn.& -eb&i&n be-&+ #e&&%&n "e+5&*i

&#ib&" *&+i m'n9'%n.& -"+&in +e-i-"en &"&' *eb+i*emen .&n "i*&# #'&",

Te+&4i +&8&" 5&%&n *en&n &#-e- #&"e"e+ in"+&en& -e4e+"i #&"e"e+

*im&-'##&n 4e+i3e+ 4'-&" #&"e"e+ Hi9#m&n &"&' #&"e"e+ G+$-/$n "e%&/

"e+b'#"i men'+&ni bi&.& 4en$b&"&n *&n 'n"'# menin#&"#&n #'&%i"&-

/i*'4 4&-ien,

Ob&" .&n "e+b'#"i be+#/&-i&" *&%&m 4en$b&"&n $+&% $-"e$mie%i"i- &*&%&/

#%in*&mi-in +i3&m4i-in #$"+im$#-&C$% *&n 3%'$+$'in$%$ne- (T&be% III),

K%in*&mi-in &n"ibi$"i# %in9$-&mi*e &#"i3 "e+/&*&4 -eb&i&n be-&+ b&#"e+i

+&m 4$-i"i3 memi%i#i bi$&&i%&bi%i"&- .&n -&n&" b&i# *&n -&&" ini *ibe+i#&n

-e9&+& $+&% -e"e%&/ 4en$b&"&n in"+&en& &8&% *&%&m *'+&-i 1 -&m4&i 2

min', LineC$%i* &n"ibi$"i# $+&% *&n in"+&en& &#"i3 "e+/&*&4 methicillin-

resistant staphylococcus "e%&/ "e+b'#"i e3e#"i3 'n"'# men$b&"i in3e#-i -e+i'-

"e+m&-'# $-"e$mie%i"i-, Te+&4i $+&% *en&n #'in$%$n 'n"'# $+&ni-me +&m

ne&"i3 -&&" ini -e*&n *i'n&#&n 4&*& 4&-ien *e8&-& *en&n $-"e$mie%i"i-,

K'in$%$n ene+&-i #e*'& (9i4+$3%$&9in *&n $3%$&9in) memi%i#i &#"ii"&-

.&n b'+'# "e+/&*&4 -4e-ie- Streptococcus -4e-ie- Enterococcus *&n b&#"e+i

&n&e+$bi9 %&inn.&, K'in$%$n ene+&-i #e"i& (%e$3%$&9in *&n &"i3%$#-&-in)

memi%i#i &#"ii"&- .&n -&n&" b&i# "e+/&*&4 -4e-ie- Streptococcus "e"&4i

memi%i#i 9&#'4&n minim&% 4&*& b&#"e+i &n&e+$bi#, Gene+&-i #eem4&"

#'in$%$n "+$&3%$&9in memi%i#i 9&#'4&n .&n -&n&" b&i# *&+i -4e-ie-

Streptococcus *&n $+&ni-me &n&e+$bi#, T+$&3%$&9in *i-e"'5'i /&n.& 'n"'#

4en$b&"&n +&8&" in&4 *&n /&+'- *i'n&#&n *en&n /&"i7/&"i #&+en& *&%&m

#&-'- .&n 5&+&n *&4&" men.eb&b#&n "$#-i-i"&- /&"i .&n -e+i'-, T&# -&"'

4'n *&+i #'in$%$n memi%i#i &#"i3i"&- .&n "e+4e+9&.& 4&*& -4e-ie-

Enterococcus" K'in$%$n .&n "e+-e*i& -&&" ini men'n5'##&n 9&#'4&n &+i&be%

1=



Staphylococcus aureus *&n Staphylococcus epidermidis *&n +e-i-"en-i $b&"

$%$n&n #'in$%$n ene+&-i #e*'& *&n #e"i& "e%&/ menin#&", Un"'# b&#"e+i

methicillin-sensitif Staphylococcus aureus /&+'- *i'n&#&n *en&n &n"ibi$"i#

$+&% .&n %&in -e4e+"i #%in*&mi-in &"&' &m4i-i%in7-'%b&#"&m, K&+en& &b-$+b-i

.&n -&n&" b&i# #'in$%$n *&4&" *ibe+i#&n -e9&+& $+&% -ee+& -e"e%&/ 4&-ien

m&m4' memin'm $b&", D$-i- "ini *&+i #e%&- #'in$%$n &n"ibi$"i# "e%&/

*i%&4$+#&n me+'-&# "'%&n +&8&n &+"i#'%&+ 4&*& /e8&n m'*& "em'&n ini

"e%&/ membe+i#&n bebe+&4& #e#/&8&"i+&n menen&i 4en'n&&n 5&n#&

4&n5&n *&+i $b&" ini 4&*& b&.i *&n &n&#7&n&#, O%e/ #&+en& i"' *&%&m

-eb&i&n be-&+ #e&*&&n 4&-ien &n&# "i*&# b$%e/ *ibe+i#&n #e%&- #'in$%$n

&n"ibi$"i#,

Ke4'"'-&n 'n"'# men'n&#&n $+&% *&+i4&*& &n"ibi$"i# 4&+en"e+&% /&+'-

*i*&-&+#&n 4&*& /&-i% -en-i"ii"&- mi#+$$+&ni-me #e4&"'/&n 4&-ien

#$n-'%"&-i #e4&*& &/%i 4en.&#i" men'%&+ *&n 4en&%&m&n *$#"e+ be*&/,

K$mbin&-i &n"ibi$"i# 4&+en"e+&% *&n $+&% .&n "e%&/ *i'n&#&n *&%&m

bebe+&4& -i"'&-i, Ri3&m4i-in $+&% -&&" ini *i'n&#&n -eb&&i $b&" #$mbin&-i

4&+en"e+&% *&n $+&% 'n"'# in3e#-i Staphylococcus aureus, N&m'n -e/&+'-n.&

4en'n&&n ini "i*&# *i%&#'#&n -e9&+& "'n&% #&+en& *&4&" mem4e+9e4&"

+e-i-"en-i #'m&n,

Me-#i4'n &#"ii"&- -e+'m b&#"e+i-i*&% "e%&/ *i#&i"#&n *en&n /&-i% .&n

men'n"'n#&n *&%&m 4en$b&"&n $-"e$mie%i"i- /em&"$en 4&*& 'm'mn.&

n&m'n "i*&# 4e+%' mem&n"&' %ee% -e+'m b&9"e+i-i*&% #&+en& #eb&n.&#&n

#e&&%&n 4en$b&"&n m'n#in #&+en& #'+&nn.& *eb+i*emen" .&n

mem&*&i *&+i4&*& &n"ibi$"i# .&n "i*&# &*e#'"&, M'n#in 4e+%' mem&n"&'

%ee% -e+'m b&9"e+i-i*&% 4&*& 4&-ien *en&n $+&ni-me +e%&"i3 +e-i-"en &"&'

'n"'# men'#'+ e3e#"ii"&- "e+&4i &n"ibi$"i# $+&%,

I*e&%n.& 4en$b&"&n $-"e$mie%i"i- /&+'- *i*&-&+#&n 4&*& /&-i% #'%"'+

16



"'%&n, Se"e%&/ -4e-imen #'%"'+ *i4e+$%e/ *en&n 9&+& bi$4-i "'%&n &"&'

-e%&m& *eb+i*emen" +e5imen &n"imi#+$b& 4&+en"e+&% *im'%&i 'n"'#

me%in*'ni 4&"$en #%ini- .&n *i9'+i&i, Se"e%&/ $+&ni-me *ii*en"i3i#&-i

4en$b&"&n *&4&" *im$*i3i#&-i -e-'&i *en&n -en-i"ii"&- mi#+$$+&ni-me

.&n "e+i-$%&-i (T&be% III), N&m'n #e"i#& 4&-ien -&#i" &#'" 4en$b&"&n

&n"ibi$"i# "i*&# b$%e/ *i"'n*& 'n"'# men'n' *eb+i*emen" "'%&n,

Pengobatan Antibiotik Berdasarkan Stadium

S"&*i'm71 $-"e$mie%i"i- (G&mb&+, 1) 4&*& &n&#7&n&# bi&-&n.& *&4&"

*i$b&"i *en&n &n"ibi$"i# "'n&% #&+en& "'%&n &n&#7&n&# -&n&" &-#'%&+

*&n memi%i#i +e-4$n .&n e3e#"i3 "e+/&*&4 in3e#-i, S"&*i'm71 $-"e$mie%i"i-

4&*& $+&n *e8&-& (G&mb&+, 2) %ebi/ "&/&n "e+/&*&4 "e+&4i *&n bi&-&n.&

*i$b&"i *en&n &n"ibi$"i# *&n in"e+en-i $4e+&"i3, P&-ien *i$b&"i *en&n "e+&4i

&n"imi#+$b& 4&+en"e+&% .&n -e-'&i -e%&m& > min' "e+/i"'n *&+i "e+&4i

ini-i&-i &"&' *&+i *eb+i*emen" $4e+&-i "e+&#/i+, Ji#& m&n&5emen me*i- &8&%

&&% *&n 4&-ien -e9&+& #%ini- "e+&n' $%e/ in3e#-i be+'%&n "'%&n *&n @

&"&' *eb+i*emen" 5&+in&n %'n&# *i4e+%'#&n "e+&4i &n"ibi$"i# %&i -e%&m& >

min',

1



1;



Te+&4i &n"ibi$"i# $+&% *&4&" *i'n&#&n 'n"'# men$b&"i -"&*i'm71

$-"e$mie%i"i- 4&*& &n&#7&n&#, N&m'n *&%&m #eb&n.&#&n -"'*i *&%&m

%i"e+&"'+ &n&#7&n&# &8&%n.& mene+im& 1 /in& 2 min' "e+&4i &n"ibi$"i#

4&+en"e+&% -ebe%'m be+'b&/ #e "e+&4i $+&%, -"&*i'm72 $-"e$mie%i"i- (Gb+, )

&n"ibi$"i# 5&n#& 4en*e# bi&-&n.& *i4e+%'#&n, D&%&m -eb'&/ -"'*i *i m&n&

4en'n&&n &n"ibi$"i# -e%&m& 2 min' *ibe+i#&n -&&" *eb+i*emen" *&+i

#$+"e#- *&n men9&n#'4 5&+in&n %'n&#, O-"e$m.e%i"i- *&4&" *i"&/&n /&m4e+

100< 4&*& host A *&n < 4&*& host B,

1



K&mi me%&#'#&n 4en$b&"&n 4&*& 4&-ien -"&*i'm7 &"&' > *&+i

$-"e$mie%i"i- *en&n "e+&4i &n"ibi$"i# -e%&m& >76 min' "e+/i"'n *&+i

*eb+i*emen "e+&#/i+, T&n4& *eb+i*emen .&n &*e#'&" #e&&%&n &#&n

-em&#in be-&+ -e%&m& 4en$b&"&n, &%&'4'n -em'& 5&+in&n ne#+$"i# -'*&/

*i *eb+i*emen" 5&+in&n -e#i"&+n.& /&+'- beb&- *&+i #$n"&min&-i 4&"$en, H&%

ini me+'4&#&n /&% .&n 4en"in -e%&m& > min' 4en$b&"&n, O-"e$m.e%i"i-

*&4&" *i"&/&n -e#i"&+ ;< 4&*& host A *&n ;0< (-"&*i'm >) -&m4&i 2<

(-"&*i'm ) 4&*& host B,

20



Terapi Supresif Antibiotik

Ke"i#& 4en$b&"&n $4e+&"i3 $-"e$mie%i"i- "i*&# *&4&" *i%&#'#&n "e+&4i&n"ibi$"i# -'4+e-i3 bi&-&n.& *ibe+i#&n -e9&+& $+&% bi&-&n.& *ibe+i#&n 'n"'#

menen*&%i#&n 4en.&#i" *&n 'n"'# men9e&/ 4e+#emb&n&n 4en.&#i",

I*e&%n.& $b&" -'4+e-i3 /&+'- memi%i#i bi$&&i%&bi%i"&- .&n b&i# memi%i#i

"$#-i-i"&- +en*&/ *&n *&4&" menemb'- "'%&n -e9&+& mem&*&i, Re5imen

-'4+e-i3 /&+'- be+*&-&+#&n /&-i% #'%"'+, Mi#+$$+&ni-me 4en.eb&b /&+'-

+en"&n "e+/&*&4 &n"ibi$"i# &"&' &n"ibi$"i# *&4&" *i'n&#&n 'n"'# -'4+e-i3,

Te+&4i -'4+e-i3 'n"'# in3e#-i *i -e#i"&+ im4%&n $+"$4e*i "e%&/ *i4e%&5&+i -e9&+&

e#-"en-i3, Ri3&m4i-in (*&%&m #$mbin&-i *en&n &n"ibi$"i# %&inn.&) &-&m

3'-i*i9 $3%$#-&-in *&n #$"+im$#-&C$% "e%&/ *ibe+i#&n -e%&m& 6 -&m4&i

b'%&n 'n"'# 4&-ien .&n memi%i#i in3e#-i *i-e#i"&+ im4%&n, Se"e%&/

4en/en"i&n 4en$b&"&n "e+*&4&" 26 *&+i 4&-ien (6<) .&n *i$b&"i

*en&n 9$"+im$&C$%e "i*&# men&%&mi #e#&mb'/&n in3e#-i -e%&m& 3$%%$8

'4 11 (==<) *&+i 20 4&-ien .&n *i$b&"i *en&n &-&m 3'-i*i9 *&n +i3&m4i-in

21



*&n 11 (=0<) *&+i 20 *'& *i$b&"i *en&n +i3&m4i-in *&n $3%$&9in, Ke&&%&n

4en$b&"&n *i-eb&b#&n $%e/ in3e#-i .&n mene"&4 &"&' +e-i-"en-i "e+/&*&4

&n"ibi$"i#, E3e#"i3i"&- "e+&4i -'4+e-i3 m'n#in men.eb&b#&n 4e+4&n5&n&n

8&#"' b&#"e+i 'n"'# be+e4%i#&-i &"&' m'n#in #&+en& *i"e#&nn.& &#-i

%.9$9&%. "e+/&*&4 -e%, E3e#"i3i"&- 4en$b&"&n -'4+e-i3 $-"e$m.e%i"i- 4&*&

"'%&n 4&n5&n "&n4& im4%&n *i "em4&" be%'m *i"en"'#&n,

Te+&4i -'4+e-i3 bi&-&n.& *ibe+i#&n -e%&m& 6 b'%&n, Ji#& "e+*&4&" in3e#-i

be+'%&n -e"e%&/ 4en/en"i&n "e+&4i b&+' *i%&#'#&n "e+&4i -'4+e*i3 -e'm'+

/i*'4,

Pengobatan Operatif

M&n&5emen $4e+&"i3 $-"e$mie%i"i- bi-& -&n&" men&n"&n, P+in-i47'n"'#

men$b&"i -e"i&4 in3e#-i be+%&#' 'n"'# 4en$b&"&n in3e#-i 4&*& "'%&n,

P+in-i474+in-i4 ini me%i4'"i *+&in&-e .&n &*e#'&" *eb+i*emen" %'&- *&+i

-em'& 5&+in&n ne#+$"i# $b%i"e+&-i +'&n m&"i (*e&* -4&9e) 4e+%in*'n&n

"e+/&*&4 5&+in&n %'n&# .&n &*e#'&" *&n mem4e+b&i#i e3e#"i3i"&- &%i+&n

*&+&/, Pen$b&"&n $4e+&"i3 4&*& host .&n #$m4+$mi-e b&/#&n %ebi/

men&n"&n, G&n'&n 3'n-i$n&% .&n *i-eb&b#&n $%e/ 4en.&#i" $4e+&-i

+e#$n-"+'#-i *&n &#ib&" me"&b$%i# "e+/&*&4 "e+&4i .&n &+e-i3

mem4en&+'/i 4emi%i/&n 4&-ien 'n"'# me%&#'#&n 4en$b&"&n, Te+#&*&n

4+$-e*'+ .&n *i4e+%'#&n 'n"'# me+in&n#&n 4en.&#i" "e+-eb'" *&4&"

men.eb&b#&n /i%&nn.& 3'n-i "'n#&i &"&' #e/i*'4&n *&+i host , O%e/

#&+en& i"' 4en$b&"&n $4e+&"i3 -"&n*&+ $-"e$mie%i"i- "i*&# *&4&" *i%&%'#&n

4&*& -em'& #&-'- "e+-eb'" *&n 4&*& bebe+&4& 4&-ien .&n "e+&n9&m 5i8&n.&

4en$b&"&n +&*i#&% *&4&" *i4i%i/ -e4e+"i &m4'"&-i &"&' men'n&#&n "e+&4i

&n"ibi$"i9 -'4+e-i,

22



Debridemen Tulang

T'5'&n *eb+i*emen" &*&%&/ menin&%#&n 5&+in&n .&n -e/&" *&n %&.&#,

Deb+i*emen" "'%&n *i%&#'#&n -&m4&i "e+*&4&" "i"i#7"i"i# 4en*&+&/&n &"&'

papria sin, N&m'n b&/#&n #e"i#& -em'& 5&+in&n ne#+$"i# "e%&/ *i

*eb+i*emen" -e9&+& "e4&"i 5&+in&n .&n "e+-i-& *i4e+"imb&n#&n "e%&/

"e+#$n"&min&-i, B&+'7b&+' ini "e%&/ *i%&#'#&n 4ene%i"i&n 4&*& "in*&#&n

$4e+&-i *eb+i*emen -e9&+& %'&- 4&*& 4&-ien .&n n$+m&% *&n 4&-ien

#$m4+$mi-e *im&n& host #$m4+$mi-e .&n *i$b&"i -e9&+& +e-e#-i m&+in&%

(.&i"' *en&n 9%e&+&n9e m&+in = mm) memi%i#i #e#&mb'/&n .&n %ebi/

"ini *&+i $+&n n$+m&%, Men'+'" 4en'%i- -"'*i "e+-eb'" +e-e#-i -e9&+& %'&-

"&m4&#n.& 5&'/ %ebi/ 4en"in 4&*& #$m4+$mi-e host -e*&n#&n +e-e#-i

m&+5in&% m'n#in *&4&" *i"e+im& 4&*& /$-" .&n n$+m&%,

Rekonstruksi Defek pada Tulang dan Manajemen Dead Space

Deb+i*emen" .&n &*e#'&" *&4&" menin&%#&n *e3e# .&n be-&+ 4&*&

"'%&n .&n *i-eb'" -eb&&i dead space, R'&n ini &*&%&/ m&-&%&/ #&+en&

&-#'%&+i-&-in.& .&n b'+'# .&n me+'4&#&n 4+e*i-4$-i-i 'n"'# in3e#-i

mene"&4, M&n&5emen .&n "e4&" *&+i -e"i&4 dead space .&n *i-eb&b#&n $%e/

*eb+i*emen" /&+'- *&4&" men9e&/ in3e#-i *&n men5&& in"e+i"&- +&n#&,

T'5'&n *&+i m&n&5emen dead space &*&%&/ 'n"'# men&n"i#&n "'%&n .&n

m&"i *&n 5&+in&n 4&+'" *en&n 5&+in&n &-#'+&+i-&-i .&n "&/&n %&m&,

raft @9&n#$# "'%&n *en&n &-#'%&+i-&-i "e%&/ "e+b'#"i -'#-e- 'n"'#

meni-i *e&* -4&9e "e+-eb'", raft ini bi&-&n.& *i4e+$%e/ *&+i 3ib'%& &"&'

i%i'm, Men'"'4@ flaps *en&n 5&+in&n %$#&% &"&' 5&+in&n beb&- 5'& *&4&"

*i'n&#&n 'n"'# meni-i dead space, Te#ni# &%"e+n&"i3 &*&%&/ *en&n

menem4&"#&n raft "'%&n 9&n9e%%$'- *ib&8&/ 5&+in&n %$#&% &"&' bi%& 4e+%'

*&4&" *i"&mb&/#&n "+&n-3e+ 5&+in&n, Pe+en9&n&&n 4+& $4e+&-i -e9&+& /&"i7/&"i

2



-&n&" 4en"in 4&*& 4&-ien .&n memi%i#i 9&*&n&n "'%&n 9&n9e%%$'-

"e+b&"&-, 1pen raft 9&n9e%%$'- "&n4& 5&+in&n %'n&# be+'n& &4&bi%& "+&n-3e+

5&+in&n b'#&n%&/ -'&"' 4i%i/&n *&n flaps 5&+in&n %$#&% "i*&# mem&*&i,

#nti!iotic-imprenated acrylic !eads *&4&" *i'n&#&n 'n"'#

men-"e+i%#&n *&n meme%i/&+& dead space -e9&+& -emen"&+&, .eads bi&-&n.&

*i/i%&n#&n *&%&m 8&#"' 27> min' *&n *i&n"i *en&n raft "'%&n

#&n-e%'-, An"ibi$"i# .&n 4&%in 'm'm *i'n&#&n *&%&m !eads &*&%&/

&n#$mi-in "$b+&m.9in *&n en"&mi-in, Tin#&" 4en&/&n&nn.& "e+/&*&4

$-"e$mie%i"i- be+#i-&+ *&+i ==< 4&*& -"'*i => 4&-ien 6< 4&*& -"'*i >6

4&-ien, K&+en& -eb&i&n be-&+ !eads be+"in*&# -eb&&i bi$m&"e+i&% *i

4e+m'#&&n -e/in& b&#"e+i *&4&" menem4e% -e/in& *&4&" men.eb&b#&n

in3e#-i .&n *i-eb&b#&n $%e/ !eads, Un"'# men/in*&+i m&-&%&/ -e4e+"i i"'

"e%&/ *i'n&#&n anti!iotic-imprenated !eads .&n "e%&/ *i'n&#&n b&+'7b&+'

*&n "e%&/ men'n5'##&n &#"i3i"&- &n"ibi$"i97+e%e&-e .&n men'n"'#&n,

Pen&mb&/&n raf "'%&n 9&%9e%%$'- anti!iotic-imprenated !eads "e%&/

*i%&#'#&n 4e+9$b&&n 4&*& >6 4&-ien *&n =< *&4&" *i"&/&n, An"ibi$"i#

(#%in*&mi-in *&n &mi#&-in) 5'& "e%&/ *ibe+i#&n %&n-'n #e dead space

*en&n 4$m4& im4%&n *&n 4embe+i&n &n"ibi$"i9 -i-"emi# %$9&% "in#&" "ini

-&m4&i +en*&/ *i%&#'#&n,

Pi%i/&n "&mb&/&n .&n *&4&" memb&n"' 4en.emb'/&n %'#& 5&+in&n

%'n&# &*&%&/ -i-"em &#'m -eb'&/ &%&" *en&n "e#&n&n ne&"i3 %$#&% *i &"&-

4e+m'#&&n %'#& *&n memb&n"' 4en&+i#&n 9&i+&n, D&%&m -&"' -"'*i #&-'-

&n&#7&n&# -i-"em ini memb&n"' 'n"'# menin#&"#&n 4emben"'#&n 5&+in&n

+&n'%&-i *&n 4en.emb'/&n 9e*e+& 5&+in&n %'n&# .&n %'&-, He+-9$i9i *##,

5'& men'n5'##&n #e'n&&nn.& -eb&&i "e+&4i "&mb&/&n 'n"'# 9e*e+&

5&+in&n %'n&# *&%&m -eb'&/ -"'*i non-random -eb&n.&# 21 4&-ien .&n

memi%i#i "+&'m& .&n be+#e%&n5'"&n 4en'%i- me%&4$+#&n b&/8& =< *&+i

2>



4&-ien "i*&# meme+%'#&n 4en$b&"&n "&mb&/&n &"&' split-raft sin .&n

"eb&% -e"e%&/ -e#i"&+ 20 /&+i 4en$b&"&n *en&n "e#&n&n ne&"i3, M&n3&&"

-i-"em &#'m -&n&" men5&n5i#&n N&m'n 'n"'# 4ene"&/'&n #i"& "i*&# &*&

'5i #%ini- "e+#$n"+$% .&n *&4&" menen"'#&n #ebe+/&-i%&n *&n +i-i#$ 4&*&

4&-ien *en&n $-"e$mie%i"i-, P&+& 4en'%i- *&+i -&%&/ -&"' -"'*i #&-'-

me%&4$+#&n b&/8& -i-"em &#'m memi%i#i 4$"en-i 'n"'# 4e+#emb&n&n

in3e#-i %'#& &n&e+$b,

Stabilisasi Tulang

Ji#& "e+*&4&" #e"i*&#-"&bi%&n 4&*& "'%&n *i "em4&" in3e#-i 4&-"i#&n

'n"'# men&mbi% "in*&#&n 'n& men9&4&i -"&bi%i"&- *en&n 4%&"e- -9+e8-

rods *&n @ &"&' 3i&"$+ e#-"e+n&%, Fi#-&-i e#-"e+n&% %ebi/ *i-'#&i *&+i4&*&

3i#-&-i in"e+n&% #&+en& memi%i#i #e9en*e+'n&n men5&*i in3e#-i -e#'n*e+ *i

me*'%& *&n men.eb&+ men5&*i in3e#-i %'&-, 3i#-&-i e#-"e+n&% I%iC&+$

mem'n#in#&n +e#$n-"+'#-i *e3e# -e9&+& -emen"&% *&n +e-i#$ in3e#-i non-

unions men5&*i -'%i", Me"$*e ini *i*&-&+#&n 4&*& "e#ni# *i-"+&#-i

$-"e$ene-i- *im&n& $-"e$"$mi *ib'&" *i *&e+&/ me"&4/i-i&% "'%&n -e9&+&

be+"&/&4 'n"'# meni-i *e3e# 4&*& "'%&n, Te#ni# I%iC&+$ *i'n&#&n 'n"'#

#&-'-7#&-'- $-"e$mie%i"i- -'%i" #e"i#& -"&bi%i-&-i *&n 4em&n5&n&n "'%&n

*i4e+%'#&n, Me"$*e ini 5'& *&4&" *i'n&#&n 'n"'# men#$m4+e-i non-

unions *&n 'n"'# mem4e+b&i#i malunions, D&%&m -"'*i *im&n& "e#ni# ini

*i'n&#&n +&"&7+&"& *&4&" men&/&n $-"e$mie%i"i- be+#i-&+ &n"&+& =< 4&*& 2;

4&-ien *&n 100< 4&*& 11 4&-ien,

Pelindung untuk aringan lunak

Pe+%in*'n&n 5&+in&n %'n&# .&n &*e#'&" *i4e+%'#&n 'n"'# men&/&n

$-"e$mie%i"i-, De3e# #e9i% 4&*& 5&+in&n %'n&# *&4&" *i"'"'4i *en&n split sin

2=



raft .&n "eb&%, Se#&+&n ini *e3e# be-&+ 4&*& 5&+in&n %'n&# &"&'

4emb'n#'- 5&+in&n %'n&# .&n in&*e#'&" flaps $"$" %$#&% *&n 3%&4-

&-#'%&+i-&-i $"$" *&4&" *i%&#'#&n 4&*& -"&*i'm71 *&n -"&*i'm72, T+&n-3e+

*&+i 3%&4- $"$" %$#&% *&n 3%&4- &-#'%&+i-&-i $"$" mem4e+b&i#i %in#'n&n

.&n bi$%$i- *en&n memb&8& -'4%&i *&+&/ .&n 4en"in 'n"'# me#&ni-me

4e+"&/&n&n host 4embe+i&n &n"ibi$"i# *&n 4en.emb'/&n "'%&n *&n 5&+in&n

%'n&#,

F%&4- $"$" %$#&% *&n mi#+$&-#'%e+ -e+"& 3%&4- mi#+$&-#'%e+ "'n&%

"e%&/ *i'n&#&n *&%&m #$mbin&-i *en&n &n"ibi$"i# *&n *eb+i*emen", Tin#&"

4en&/&n&n "e+/&*&4 $-"e$mie%i"i- .&n be+#i-&+ &n"&+& 0< *&%&m -"'*i

4&-ien 100< *&%&m -"'*i 1; 4&-ien,

P&*& &#/i+n.& 4en.emb'/&n *en&n 9&+& -e#'n*e+ /&+'- #/&8&"i+ bi%&

5&+in&n 4&+'" .&n meni-i *e3e# m'n#in &#&n men5&*i &&-9'%&+,

Pen'"'4&n %'#& /&+'- *i%&#'#&n bi%& menin#in#&n,

Me-#i4'n "e+*&4&" #em&5'&n &n"ibi$"i# *&n 4en$b&"&n $4e+&"i3

$-"e$mie%i"i- "e"&4 -'%i" 'n"'# *i$b&"i, B&#"e+i *&4&" men9&4&i "'%&n me%&%'i

&%i+&n *&+&/ *&+i 3$#'- in3e#-i .&n be+*e#&"&n -eb&&i &#ib&" *&+i "+&'m&

"emb'- &"&' *&+i in"e+en-i $4e+&"i3, T'%&n .&n ne#+$-i- "e+5&*i *i&8&%

men&+&/ #e 4+$-e- #+$ni- *&n mem4e+-'%i" '"'# #em'n#in&n e+&*i#&-i

#'m&n, A*&n.& 5&+in&n *en&n &-#'%&+i-&-i .&n b'+'# 4e+%e#&"&n b&#"e+i

*i-"+'#"'+ "'%&n *&n im4%&n *&n +e4%i#&-i b&#"e+i .&n %&mb&" -em'&n.&

be+#$n"+ib'-i men.eb&b#&n in3e#-i .&n mene"&4, Pen$b&"&n .&n "e4&"

'n"'# $-"e$mie%i"i- "e+*i+i *&+i "e+&4i &n"imi#+$b& .&n &*e#'&" *&n

*eb+i*emen" $4e+&"i3 -em'& "'%&n *&n 5&+in&n %'n&# .&n ne#+$"i#,

Pen$b&"&n &n"ibi$"i# /&+'- *i"en"'#&n be+*&-&+#&n /&-i% #'%"'+ *&n

meni*en"i3i#&-i -en-i"ii"&-n.& "e+/&*&4 &n"ibi$"i#, Pen$b&"&n -e+in

me%ib&"#&n #$mbin&-i *&+i &n"ibi$"i#, Pen$b&"&n $4e+&"i3 /&+'- men9&#'4

26



*eb+i*emen" $b%i"e+&-i dead space 4e+%in*'n&n 5&+in&n %'n&# .&n

&*e#'&" 4em'%i/&n -'4%&i *&+&/ *&n -"&bi%i-&-i, In"e+&#-i .&n b&i# &n"&+&

be+b&&i -4e-i&%i- (&/%i be*&/ $+"$4e*i *$#"e+ be*&/ 4%&-"i# *&n 4emb'%'/

*&+&/ *&n -4e-i&%i- 4en.&#i" men'%&+) -&n&" 4en"in 'n"'# menin#&"#&n

mene5emen 4en.&#i" ini,

B. T,ra)i i,% hi),rari )a'a t,mi,*iti

a. S,+arah Hi),rari

Te+&4i $#-ien /i4e+b&+i# *i4e+#en&%#&n 4e+"&m& #&%i $%e/ Be/n#e 4&*&

"&/'n 10, S&&" i"' "e+&4i $#-ien /i4e+b&+i# /&n.& *ibe+i#&n #e4&*& 4&+&

4en.e%&m 'n"'# men/i%&n#&n e5&%& 4en.&#i" *e#$m4+e-i (Caisson2s

disease) .&n "imb'% &#ib&" 4e+'b&/&n "e#&n&n '*&+& -&&" men.e%&m

-e/in& 3&-i%i"&- "e+&4i "e+-eb'" -eb&i&n be-&+ /&n.& *imi%i#i $%e/ bebe+&4&

+'m&/ -&#i" TNI AL *&n +'m&/ -&#i" .&n be+/'b'n&n *en&n

4e+"&mb&n&n.Te+&4i /i4e+b&+i# m'n#in b&+' -ee%in"i+ $+&n .&n menen&%n.&, Di

In*$ne-i& -en*i+i "e+&4i $#-ien /i4e+b&+i# 4e+"&m& #&%i *im&n3&&"#&n 4&*&

"&/'n 160 $%e/ L&#e-%& .&n be#e+5&-&m& *en&n RSAL D+, R&me%&n

S'+&b&.&, Hin& -&&" ini 3&-i%i"&- "e+-eb'" me+'4&#&n .&n "e+be-&+ *i

In*$ne-i&, A*&4'n bebe+&4& +'m&/ -&#i" %&in .&n memi%i#i 3&-i%i"&- "e+&4i

$#-ien /i4e+b&+i# &*&%&/! (RS PT A+'n A9e/ RSAL D+ Mi*i.&"$- T&n5'n

Pin&n RSAL D+ Min"$/&+*5$ J&#&+"& RS Pe+"&min& ?i%&9&4 RS P&n"i

&%'.$ S$%$ L&#e-%& TNI AL S'+&b&.& RSU S&n%&/ Den4&-&+ RS

Pe+"&min& B&%i#4&4&n RS G'n'n en&n M&n&*$ RSU M&#&-&+ RSAL

H&%$n Amb$n RS Pe"+$me+ S$+$n).

D&-&+ *&+i "e+&4i /i4e+b&+i# -e*i#i" b&n.&# men&n*'n 4+in-i4 3i-i#&,

Te$+i T$+i9e%%i .&n men*&-&+i "e+&4i *i'n&#&n 'n"'# menen"'#&n "e#&n&n

'*&+& 1 &"m &*&%&/ 60 mmH, D&%&m "e#&n&n '*&+& "e+-eb'" #$m4$-i-i

2



'n-'+7'n-'+ '*&+& .&n "e+#&n*'n *i *&%&mn.& men&n*'n Ni"+$en (N2)

< *&n O#-ien (O2) 21<, D&%&m 4e+n&3&-&n #i"& 4'n *emi#i&n, P&*&

"e+&4i /i4e+b&+i# $#-ien +'&n&n .&n *i-e*i&#&n men&n*'n O#-ien (O 2)

100<, Te+&4i /i4e+b&+i# 5'& be+*&-&+#&n "e$+i 3i-i#& *&-&+ *&+i /'#'m7

/'#'m D&%"$n B$.%e ?/&+%e- *&n Hen+.,

Se*&n#&n 4+in-i4 .&n *i&n'" -e9&+& 3i-i$%$i- &*&%&/ b&/8& "i*&#

&*&n.& O2 4&*& "in#&" -e%'%e+ &#&n men.eb&b#&n &n'&n #e/i*'4&n 4&*&

-em'& $+&ni-me, O#-ien .&n be+&*& *i -e#e%i%in "'b'/ m&n'-i& m&-'# #e

*&%&m "'b'/ me%&%'i 9&+& 4e+"'#&+&n &-, F&-e73&-e +e-4i+&-i *&+i 4e+"'#&+&n

&- "e+*i+i *&+i 3&-e en"i%&-i "+&n-4$+"&-i '"i%i-&-i *&n *i33'-i, Den&n

#$n*i-i "e#&n&n $#-ien .&n "ini *i/&+&4#&n m&"+i#- -e%'%e+ .&n

men$4&n #e/i*'4&n -'&"' $+&ni-me men*&4&"#&n #$n*i-i .&n $4"im&%.

Te+&4i $#-ien /i4e+b&+i# (HBOT) &*&%&/ "e+&4i me*i- *im&n& 4&-ien

*&%&m -'&"' +'&n&n men/i-&4 $#-ien "e#&n&n "ini (100<) &"&' 4&*&

"e#&n&n b&+$me"e+ "ini (hyper!aric cham!er ), K$n*i-i %in#'n&n *&%&m

HBOT be+"e#&n&n '*&+& .&n %ebi/ be-&+ *ib&n*in#&n *en&n "e#&n&n *i

*&%&m 5&+in&n "'b'/ (1 ATA), Ke&*&&n ini *&4&" *i&%&mi $%e/ -e-e$+&n 4&*&

8&#"' men.e%&m &"&' *i *&%&m +'&n '*&+& .&n be+"e#&n&n "ini (RUBT)

.&n *i+&n9&n b&i# 'n"'# #&-'- 4en.e%&m&n m&'4'n 4en$b&"&n 4en.&#i"

#%ini-, In*ii*' .&n men*&4&" 4en$b&"&n HBOT &*&%&/ -'&"' #e&*&&n

in*ii*' .&n be+&*& *i *&%&m +'&n&n be+"e#&n&n "ini (1 ATA) *&n

be+n&3&- *en&n $#-ien 100<, Te#&n&n &"m$-3e+ 4&*& 4e+m'#&&n &i+ %&'"

-ebe-&+ 1 &"m, Se"i&4 4en'+'n&n #e*&%&m&n #&#i "e#&n&n &#&n n&i# 1 &"m,

Se$+&n &/%i "e+&4i /i4e+b&+i# L&#-m& D+, *+, M, G'+i"n$ S SMHS DEA

.&n "e%&/ men*&%&mi i%m' $#-ien /i4e+b&+i# *i Pe+&n9i- -e%&m& = "&/'n

men5e%&-#&n b&/8& "e+*&4&" *'& 5eni- *&+i "e+&4i /i4e+b&+i# e3e# me#&ni#

*&n 3i-i$%$i-, E3e# 3i-i$%$i- *&4&" *i5e%&-#&n me%&%'i me#&ni-me $#-ien

.&n "e+%&+'" 4%&-m&, Pen&n#'"&n $#-ien #e 5&+in&n menin#&" -ei+in

2;



*en&n 4enin#&"&n $#-ien "e+%&+'" *&%&m 4%&-m&, B&/#&n #i&n 4$4'%e+n.&

#/&-i&" *&n m&n3&&" "e+&4i ini 4em&#&i&nn.& "e%&/ -em&#in me%'&- -eb&&i

"e+&4i #eb'&+&n "'b'/ -e+"& 'n"'# #e9&n"i#&n -eb&&i "e+&4i .&n be+"'5'&n

membe+i#&n e3e# "&m4i% &8e" m'*&,

. Oi,% hi),rari

O#-ien &*&%&/ -'&"' &- .&n me+'4&#&n 'n-'+ i"&% *&%&m 4+$-e-

me"&b$%i-me -e%'+'/ -e% "'b'/, A*&n.& #e#'+&n&n $#-ien *&4&"

men.eb&b#&n #em&"i&n 5&+in&n *&n men&n9&m #e/i*'4&n -e-e$+&n,

Te"&4i "i*&# b&n.&# $+&n .&n "&/' -e%&in *&%&m 4+$-e- 4e+n&3&-&n *&n

me"&b$%i-me $#-i&n 5'& memi%i#i 4e+&n *&%&m 4emben"'#&n #$%&en *&n

4e+b&i#&n 5&+in&n -e/in& 4embe+i&n $#-ien .&n *&4&" memb&n"' *&%&m

4+$-e- 4en.emb'/&n %'#& m&'4'n *&%&m 4+$-e- &n"i 4en'&&n"

Se9&+& 'm'm "e+&4i $#-ien /i4e+b&+i# (HBOT H.4e+b&+i9 $.en

"/e+&4.) me+'4&#&n -'&"' me"$*& 4en$b&"&n *im&n& 4&-ien *ibe+i#&n

4e+n&4&-&n $#-ien m'+ni (100<) 4&*& "e#&n&n '*&+& .&n *'& /in& "i&

#&%i %ebi/ be-&+ *&+i4&*& "e#&n&n '*&+& &"m$-3e+ n$+m&% .&i"' 1 &"m (60

mmH), Ke&*&&n ini *&4&" *i&%&mi $%e/ -e-e$+&n 4&*& 8&#"' men.e%&m

&"&' be+&*& *&%&m +'&n&n '*&+& be+"e#&n&n "ini (/.4e+b&+i9 9/&mbe+)

.&i"' -'&"' +'&n #e*&4 '*&+& "e+b'&" *&+i 4e+&n#&" #e+&- .&n m&m4'

*ibe+i#&n "e#&n&n %ebi/ be-&+ *&+i 1 &"m (+'&n #$m4+e-i) be-e+"& -'mbe+

$#-ien *&n -i-"em 4en.&%'+&nn.& #e *&%&m +'&n +e#$m4+e-i "e+-eb'",

D&%&m #$n*i-i n$+m&% $#-ien *ib&8& $%e/ -e% *&+&/ me+&/ #e-e%'+'/

"'b'/, Te#&n&n '*&+& .&n "ini &#&n men.eb&b#&n 5'm%&/ $#-ien .&n

*ib&8& $%e/ -e% *&+&/ me+&/ menin#&" /in& >00<,Te+&4i ini me+'4&#&n

"e+&4i #$m4%emen"e+ .&n *i%&#'#&n be+-&m& *en&n "e+&4i me*i-

#$nen-i$n&%,

. M,a%im, P,%ata% Hi),rari

2



Hi4e+b&+i# $#-ien "e+&4i (HBOT) memi%i#i me#&ni-me *en&n

mem$*'%&-i ni"+i" $#-i*e (NO) 4&*& -e% en*$"e%, P&*& -e% en*$"e% ini HBOT

5'& menin#&"#&n in"e+me*ie" &-#'%e+ en*$"e% +$8"/ 3&9"$+ (+E3 ),

Me%&%'i -i#%'- K+eb- "e+5&*i 4enin#&"&n NADH .&n memi9' 4enin#&"&n

3ib+$b%&-", Fib+$b%&-" .&n *i4e+%'#&n 'n"'# -in"e-i- 4+$"e$%i#&n *&n

be+-&m& *en&n +E3 &#&n mem&9' #$%&en -in"e-i- 4&*& 4+$-e-

+em$*e%in -&%&/ -&"' "&/&4&n *&%&m 4en.emb'/&n %'#&.

O#-ien /i4e+b&+i# &*&%&/ -'&"' 9&+& 4en$b&"&n *im&n& 4&-ien

men/i+'4 $#-ien m'+ni (100<) 4&*& "e#&n&n '*&+& %ebi/ be-&+ *&+i 4&*&

"e#&n&n '*&+& &"m$-3e+ n$+m&%, Pen$b&"&n $#-ien /i4e+b&+i# ini

be+4en&+'/ 4&*& 4eni+im&n $#-ien -e9&+& -i-"emi# *im&n& "e+5&*i

4enin#&"&n 2 -&m4&i #&%i %ebi/ be-&+ *&+i 4&*& &"m$-3i+ bi&-&, Me#&ni-me

*i &"&- be+/'b'n&n *en&n -&%&/ -&"' m&n3&&" '"&m& HBOT .&i"' 'n"'#

4ound healin , P&*& b&i&n %'#& "e+*&4&" b&i&n "'b'/ .&n men&%&mi

e*em& *&n in3e#-i, Di b&i&n e*em& ini "e+*&4&" +&*i#&% beb&- *&%&m 5'm%&/

.&n be-&+, D&e+&/ e*em& ini men&%&mi #$n*i-i /i4$7$#-ien #&+en&

/i4$4e+3'-i, Penin#&"&n 3ib+$b%&-" -eb&&im&n& "e%&/ *i-in'n

-ebe%'mn.& &#&n men*$+$n "e+5&*in.& &-$*i%&"&-i 4&*& *&e+&/ e*em&

"e+-eb'", J&*i%&/ #$n*i-i *&e+&/ %'#& "e+-eb'" men5&*i /i4e+&-#'%&+

/i4e+-e%'%e+ *&n /i4e+$#-i&, Den&n 4em&4&+&n $#-ien "e#&n&n "ini

"e+5&*i 4enin#&"&n IFN7 i7NOS *&n +E3 , IFN7 men.eb&b#&n TH71

menin#&" .&n be+4en&+'/ 4&*& B79e%% -e/in& "e+5&*i 4enin#&"&n I7G,

Den&n menin#&"n.& I7G e3e# 3&$-i"$-i- %e'#$-i" 5'& &#&n menin#&",

Se/in& *&4&" *i-im4'%#&n b&/8& 4&*& %'#& HBOT be+3'n-i men'+'n#&n

in3e#-i *&n e*em&,

A*&4'n 9&+& HBOT 4&*& 4+in-i4n.& &*&%&/ *i&8&%i *en&n 4embe+i&nO2

100< "e#&n&n 2 : A"m, T&/&4 -e%&n5'"n.& *i%&n5'"#&n *en&n 4en$b&"&n

decompresion sicness" M&#& &#&n "e+5&*i #e+'-&#&n 5&+in&n 4en.emb'/&n

0



%'#& /i4$#-i& -e#i"&+ %'#&, K$n*i-i ini &#&n memi9' menin#&"n.&

3ib+$b%&-" -in"e-& #$%&en +&-i$ RNA@DNA 4enin#&"&n leuosit illin

-e+"& &ni$ene-i- .&n men.eb&b#&n ne$&-#'%&+i-&-i 5&+in&n %'#&,

Kem'*i&n &#&n "e+5&*i 4enin#&"&n *&n 4e+b&i#&n &%i+&n *&+&/

mi#+$&-#'%&+, Den-i"&- #&4i%e+ menin#&" -e/in& *&e+&/ .&n men&%&mi

i-#emi& &#&n men&%&mi reperfusi, Seb&&i +e-4$n &#&n "e+5&*i 4enin#&"&n

NO /in& > : = #&%i *en&n *ii+ini 4embe+i&n $#-ien /i4e+b&+i# 27 ATA

-e%&m& 2 5&m, H&-i%n.& 4'n 9'#'4 mem'&-#&n .&i"' 4en.emb'/&n 5&+in&n

%'#&, Te+&4i ini 4&%in b&n.&# *i%&#'#&n 4&*& 4&-ien *en&n *i&be"e- me%%i"'-

*im&n& memi%i#i %'#& .&n -'#&+ -emb'/ #&+en& b'+'#n.& 4e+3'-i 4e+i3e+

*&n $#-ien&-i 5&+in&n *i *i-"&%, Sebe%'m men5&%&ni "e+&4i me#&ni-me .&n

4&%in '"&m& &*&%&/ -ebe%'m "e+&4i 4&-ien /&+'- men5&%&ni 4eme+i#-&&n

"e+%ebi/ *&/'%' &n"&+&n.&!

• Men.eb'"#&n &"&' meni-i +i8&.&" #e-e/&"&n 4&-ien, H&% ini 4en"in

*i%&#'#&n 'n"'# men/in*&+i "e+5&*in.& #$n"+&in*i#&-i *&n #$m4%i#&-i,

• Me%&#'#&n 4eme+i#-&&n 3$"$ "$+&#- (+$n"en), T'5'&nn.& 'n"'#

men*e"e#-i &4&#&/ 5&n"'n *&n 4&+'74&+' *&%&m #$n*i-i b&i# &"&'

-eb&%i#n.&, Ji#& "e+n.&"& men&%&mi "'be+#$%$-i- mi-&%n.& #$n-'%"&-i#&n

4&*& &/%i 4&+' &&+ *i$b&"i, Bi%& 4e+%' 4&-ien *i&n5'+#&n membe%i m&-#e+

-en*i+i 'n"'# men/in*&+i 4en'%&+&n 4en.&#i" i"' 4&*& $+&n %&in, In"in.&

4eme+i#-&&n ini be+"'5'&n mene"&/'i -e9&+& 4e+-i- #$n*i-i #e-e%'+'/&n -i

4&-ien *&n 'n"'# men9&+i 3&#"$+ 4en.eb&b 4en.&#i", Se#&%i %&i '4&.&

"e+-eb'" *i%&#'#&n -em&"&7m&"& 'n"'# men/in*&+i #em'n#in&n e3e#

-&m4in .&n "e+5&*i

'. T,ra)i i,% hi),rari )a'a a& t,m3,*iti

Pen$b&"&n $-"e$m.e%i"i- #$m4%e#- *&n -'%i" *&n memb'"'/#&n

1



4en*e#&"&n m'%"i*i-i4%in, &%&'4'n $4e+&-i *eb+i*emen *&n 4en$b&"&n

*en&n &n"ibi$"i# "e%&/ *i%&#'#&n "e+&4i memb'"'/#&n 8&#"' .&n %&m& *&n

/&-i% &#/i+n.& *&4&" "i*&# -e-'&i *en&n /&+&4&n, Ke&&%&n "e+&4i 4&*&

$-"e$m.e%i"i- mem4'n.&i be+b&&i m&9&m 3&9"$+ &n"&+& %&in .&n be+4e+&n

&*&%&/ &%i+&n *&+&/ .&n be+#'+&n /i4$#-i& *&n i-#emi& 5&+in&n, O%e/

#&+en& i"' &#/i+7&#/i+ ini *i#emb&n#&n "e+&4i &*5'&n" 'n"'# "e+&4i

$-"e$m.e%i"i-, Te+&4i $#-ien /i4e+b&+i# &*&%&/ -&%&/ -&"' "e+&4i &*5'&n"

.&n 4&%in 4$"en-i&% *&n .&n "e+-e+in *i'n&#&n -eb&&i &*5'&n" 4&*&

"e+&4i $-"e$m.e%i"i-, Te+&4i HBO menin#&"#&n "e#&n&n $#-ien 5&+in&n

"'%&n *&n 5&+in&n %'n&# .&n men&%&mi 4en.emb'/&n &#ib&" i-#emi#,

Me#&ni-me HBO *&%&m 4en$b&"&n $-"e$mie%i"i- &*&%&/!

1, Menin#&"#&n "e#&n&n $#-ien 4&*& 5&+in&n

2, Menin#&"#&n me#&ni-me 3&$-i" %e'#$-i" 4&*& "'%&n *&n %'#& *en&n

"e#&n&n $#-ien +en*&/

, Te#&n&n $4"im&% $#-ien menin#&"#&n $-"e$ene-i- &"&'

ne'+$&-#'%&+i-&-i 4&*& *&e+&/ .&n men&%&mi #em&"i&n 5&+in&n

4emb'%'/ *&+&n &"&' 5&+in&n %'n&#

>, HBO menin#&"#&n &#"ii"&- $-"e$#%&-"i# 'n"'# men/i%&n#&n *eb+i-

4&*& "'%&n *&n 5'& men/&mb&" 4e+"'mb'/&n $+&ni-me &n&e+$bi#

*&%&m 5&+in&n /i4$#-i&

Te#&n&n $#-ien n$+m&% 4&*& "'%&n .&n -e/&" &*&%&/ -e#i"&+ >= mmH

$#-ien *i b&8&/ #$n*i-i +'&n&n, J&+in&n "'%&n .&n "e+in3e#-i *&n

ne#+$"i# men.eb&b#&n 4en'+'n&n "e#&n&n $#-ien .&i"' 2 mmH, H&% ini

men.eb&b#&n &n'&n &-#'%&+ 4emben"'#&n 5&+in&n 4&+'" 4&*& 5&+in&n

"'%&n .&n "e+in3e#-i, Se/in& 'n"'# mem4e+b&i#i #$n*i-i "e+-eb'"

*ib'"'/#&n "e#&n&n $#-ien -e#i"&+ 07 >0 mmH, Te#&n&n ini *ib'"'/#&n

'n"'# 4emben"'#&n ne'+$&-#'%&+i-&-i *&%&m 5&+in&n .&n men&%&mi

i-#emi# *&n menin#&"#&n #i%%in %e'#$-i", &%&'4'n 4embe+i&n &n"ibi$"i#

*&4&" memb'n'/ mei#$$+&ni-me *&%&m 5&+in&n %'n&# *i &+e& in3e#-i *&n

2



$4e+&-i men/i%&n#&n 5&+in&n .&n m&"i 4&*& "'%&n .&n "e+in3e#-i n&m'n

HBO mem4e+b&i#i +e-4$n /$-" *en&n memb'&" %in#'n&n %ebi/

men'n"'n#&n 'n"'# memb'n'/ %e'#$-i" $#-i*&"i3 ne'+$&-#'%&+i-&-i *&n

+e-$+-4-i "'%&n .&n men&%&mi i-#emi# *&n "e+-in3e#-i, Se%i&n i"' "e+&4i

HBO menin#&"#&n "+&n-4$+"&-i *&n men&mb&/#&n #em&n5'+&n "e+&4i

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PENGARUH TERAPI HIPERBARIK OKSIGEN TERHADAP PASIEN OSTEOMIELITIS 2, PEMBIMBNG DR. HISNINDARSYAH, DR....

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