pengaruh hiperbarik oksigen terapi terhadap osteomielitis (dr. hisnindarsyah, se., m.kes.)

8/16/2019 Pengaruh Hiperbarik Oksigen Terapi Terhadap OSTEOMIELITIS (Dr. Hisnindarsyah, SE., M.kes.)

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BAGIAN ILMU KESEHATAN MASYARAKAT

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

REFERAT

MARET 2016

TERAPI OKSIGEN HIPERBARIK PADA PASIEN OSTEOMIELITIS

Pembimbing

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

Le!!& L%&! 'K( )*+ An)i"% Ag&,

Di,&,&n O$e.

1. Elawia Sufiana Oei (2009!"00"#

2. $%a%&a A'ena )*a+a (2009!"00,#

". Ria Lele+u-u Tu*-e& (2009!"01#

,. /an Ain3 Ia4anua (2009!"0"0#

DIBAAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

PADA BAGIAN ILMU KESEHATAN MASYARAKAT

RSAL D*+ F+ SUHARDO

FAKULTAS KEDOKTERAN

UNIVERSITAS PATTIMURA

AMBON

2016

0


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TERAPI OKSIGEN HIPERBARIK PADA PASIEN OSTEOMIELITIS

A. O*e3+ieli*i

a. Pena%uluan

O,!e#mie$i!i, 3%)% !&$%ng 3%n4%ng m%,i. me*&3%"%n m%,%$%. )%n b&!&.

bi%-% -%ng be,%* &n!&" )i#b%!i/ me,"i3&n !e*)%3%! "em%4&%n 3%)% %n!ibi#!i"

)%n !e"ni" #3e*%,i b%*&+ R%)i#g*%5i !e!%3 membe*i"%n ,"*ining -%ng !e*b%i"

&n!&" #,!e#m-e$i!i, %"&! )%n "*#ni"+ Te"ni" 3eni!*%%n -%ng $%in )%3%!

)ig&n%"%n &n!&" menen!&"%n )i%gn#,i, )%n memb%n!& menen!&"%n

3eng#b%!%n+ Ke3&!&,%n &n!&" mengg&n%"%n %n!ibi#!i" #*%$ %!%& 3%*en!e*%$

.%*&, be*)%,%*"%n .%,i$ "&$!&* ,en,i!i5i!%, mi"*##*g%ni,me/ "e%)%%n 3%,ien/

"#n,&$!%,i )eng%n %.$i be)%.+ An!ibi#!i" ,&3*e,i5 .%*&, ,e,&%i )eng%n .%,i$

"&$!&*+ Peng#b%!%n )eng%n #3e*%,i ,!%n)%* m&ng"in !i)%" )%3%! )i$%"&"%n

3%)% ,em&% 3%,ien "%*en% !e$%. !e*4%)i "e*&,%"%n 5&ng,i -%ng )i,eb%b"%n #$e.

3en-%"i!/ #3e*%,i *e"*#n,!*&",i )%n "#n,e"&en,i me!%b#$i" )%*i !e*%3i -%ng

%g*e,i5+ Te*%3i be)%. me$i3&!i )eb*i)emen!/ #b$i!e**%,i dead space/ 3e*b%i"%n

7%,"&$%*i,%,i/ 3e*$in)&ng%n 4%*ing%n $&n%" -%ng %)e"&%!/ ,!%bi$i,%,i )%n

*e"*#n!*&",i+

5. Definii

O,!e#mie$i!i, )i)e5ini,i"%n ,eb%g%i in5e",i 3%)% !&$%ng+ Be*%,%$ )%*i "%!%

#,!e#n '!&$%ng( )%n m-e$# ',&m,&m !&$%ng( )ig%b&ng"%n )eng%n i!i,

'3e*%)%ng%n( -%ng )i)e5ini,i"%n ,eb%g%i "e%)%%n "$ini, )im%n% !&$%ng

!e*in5e",i #$e. mi"*##*g%ni,me+ O,!e#mie$i!i, 3%)% !&$%ng 3%n4%ng me$i3&!i

in5e",i -%ng be*be)% ,%!& ,%m% $%in be*"%i!%n )eng%n )&*%,i/ e!i#$#gi/

3%!#gene,i,/ !ing"%! "e!e*$ib%!%n !&$%ng/ )%n 4eni, 3%,ien 'b%-i/ %n%"/ )e8%,%/

3%,ien compromised %!%& uncompromised)+ D%$%m !ig% 3&$&. !%.&n !e*%".i*/

1


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3%!#gene,i, 3en-%"i! ini .%m3i* )%3%! )i"$%*i5i"%,i )%n b%n-%" 5%"!#* -%ng

!e$%. )ii)en!i5i"%,i mengen%i in5e",i !e*,eb&!+ Se4&m$%. %gen %n!imi"*#b%/

)eng%n ,3e"!*&m -%ng be*be)% !e*.%)%3 %"!i7i!%, 3%!.#gen/ 3e*be)%%n )%$%m

.%$ 5%*m%"#"ine!i" )%n 5%*m%"#)in%mi"/ !e$%. )ig&n%"%n &n!&" meng#b%!i

#,!e#mie$i!i,+ Me!#)e #3e*%,i b%*&/ !e*m%,&" mengg&n%"%n flaps muscle/

!e"ni" I$i9%*#7/ )%n antibiotic-loaded beads/ !e$%. )i!e*%3"%n &n!&" in5e",i

!&$%ng+ Me,"i3&n b%n-%" "em%4&%n/ #,!e#mie$i!i, !e!%3 ,&$i! &n!&" )i#b%!i/

)%n %ng"% "e,emb&.%nn-% m%,i. !i)%" mem&%,"%n+

6. Klaifi-ai

Me,"i3&n %)% bebe*%3% ,i,!em &n!&" meng"$%,i5i"%,i"%n #,!e#mie$i!i,

-%ng !e$%. )i4e$%,"%n #$e. 3en&$i, -%ng be*be)%/ %)% )&% -%ng 3%$ing b%n-%"

)ig&n%"%n )%$%m $i!e*%!&* me)i, )%n 3*%"!e" "$ini, -%ng )i,%4i"%n #$e.

%$)7#ge$ )"" )%n :ie*n- )""+ D%.&$&/ #,!e#mie$i!i, )ig%mb%*"%n ,eb%g%i

in5e",i %"&! %!%& "*#ni, men&*&! )&*%,i 3en-%"i!n-%+ O,!e#mie$i!i, 4&g%

)i"$%,i5i"%,i"%n men&*&! ,&mbe* in5e",i .em%!#gen/ %3%bi$% in5e",i be*%,%$

)%*i b%"!e*emi% )%n ,eb%g%i 5#"&, in5e",i -%ng be*)e"%!%n "e!i"% be*%,%$ )%*i

in5e",i )e"%! 4%*ing%n+ K%!eg#*i "e!ig% )%$%m "$%,i5i"%,i ini %)%$%.

#,!e#mie$i!i, -%ng !imb&$ "%*en% in,&5i,ien,i 7%,"&$%*+ K%!eg#*i $%in -%ng

!i)%" )i%ngg%3 #$e. %$)7#ge$ )""/ n%m&n ,em%"in *e$e7%n/ %)%$%. in5e",i

-%ng be*%,%$ )%*i 3ene!*%,i $%ng,&ng mi"*##*g%ni,me "e )%$%m !&$%ng/ ,e3e*!i

-%ng m&ng"in !e*4%)i 3%)% e)e*% %!%& 3embe)%.%n+ K%*en% b%n-%"n-%

7%*i%,i )%$%m e!i#$#gi #,!e#mie$i!i,/ "$%,i5i"%,i be*)%,%*"%n 3%!#gene,i,

3en-%"i!/ ,e3e*!i %$)7#ge$ )""+/ mem3&n-%i ni$%i -%ng "ei$ )%$%m 3*%"!e"

"$ini,+

K$%,i5i"%,i $%in -%ng bi%,% )ig&n%"%n )ig%mb%*"%n #$e. :ie*n- )""+

Si,!em ini/ )i"en%$ ,eb%g%i "$%,i5i"%,i :ie*n-;M%)e*/ me$i3&!i < ,!%)i&m

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%n%!#mi

1+ S!%)i&m 1/ %!%& me)&$%*i/ #,!e#mie$i!i, .%n-% !e*b%!%, 3%)% *#ngg% me)&$%

!&$%ng+ O,!e#mie$i!i, .em%!#gen )%n %)%n-% in5e",i 3%)% in!*%me)&$$%

%)%$%. #n!#. ,!%)i&m ini+

2+ S!%)i&m 2/ %!%& ,&3e*5i,i%$/ #,!e#mie$i!i, .%n-% me$ib%!"%n !&$%ng "#*!i"%$

)%n bi%,%n-% be*%,%$ )%*i in#"&$%,i $%ng,&ng %!%& 5#"&, in5e",i -%ng

be*)e"%!%n+

=+ S!%)i&m =/ %!%& $#"%$/ #,!e#mie$i!i, bi%,%n-% me$ib%!"%n b%gi%n "#*!i"%$

)%n me)&$% )%*i !&$%ng+ N%m&n/ )%$%m !%.%3 ini/ !&$%ng m%,i. ,!%bi$

"%*en% 3*#,e, in5e",i !i)%" me$ib%!"%n ,e$&*&. )i%me!e* !&$%ng+


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Me,"i3&n )e5ini,i : .#,! .%n-% &n!&" bebe*%3% !%n)% ,&b4e"!i5/

"$%,i5i"%,i ini !%m3%"n-% men4%)i ni$%i )%$%m 3*%"!e" "$ini, )%n !e$%.

)ig&n%"%n )%$%m bebe*%3% 3ene$i!i%n "$ini, )%*i 3eng#b%!%n %n!ibi#!i" )%n

#3e*%!i5+

. E*i3l37i

P%)% #,!e#mie$i!i, .em%!#gen/ #*g%ni,me 3%!#gen !&ngg%$ .%m3i* ,e$%$&

)%3%! )i,emb&."%n )%*i !&$%ng+ P%)% b%-i/ Staphylococcus aureus,

Streptococcus agalactiae/ )%n Escherichia coli %)%$%. -%ng 3%$ing ,e*ing

)ii,#$%,i )%*i )%*%. %!%& !&$%ng+ N%m&n/ 3%)% %n%";%n%" )i %!%, &,i% ,%!&

!%.&n/ Staphylococcus aureus, Streptococcus pyogenes/ )%n Haemophilus

influenzae -%ng 3%$ing ,e*ing )ii,#$%,i+ Ke4%)i%n in5e",i Haemophilus

influenzae men&*&n ,e!e$%. &,i% em3%! !%.&n+ D%n 4&g%/ "e4%)i%n "e,e$&*&.%n

Haemophilus influenzae ,eb%g%i 3en-eb%b #,!e#mie$i!i, men&*&n "%*en%

7%",in Haemophilus influenzae -%ng b%*& ,e"%*%ng ini !e$%. )ibe*i"%n "e3%)%

%n%";%n%"+ P%)% #*%ng )e8%,%/ Staphylococcus aureus %)%$%. #*g%ni,me

-%ng 3%$ing &m&m )ii,#$%,i+

Bebe*%3% #*g%ni,me bi%,%n-% !e*i,#$%,i )%*i !&$%ng -%ng !e*in5e",i

,eb%g%i %"ib%! )%*i in#"&$%,i $%ng,&ng %!%& 5#"&, in5e",i -%ng be*)e"%!%n+

Staphylococcus aureus !e!%3 men4%)i 3%!#gen -%ng 3%$ing ,e*ing )ii,#$%,i+

N%m&n/ #*g%ni,me b%,i$ g*%m neg%!i5 %n%e*#bi" 4&g% ,e*ing !e*i,#$%,i+ TB:

!&$%ng %)%$%. .%,i$ )%*i 3en-eb%*%n .em%!#gen )%*i Mycobacterium

tuberculosis )i %8%$ 3e*4%$%n%n in5e",i 3*ime*+ %*%ng/ TB: !&$%ng )i,eb%b"%n

#$e. in5e",i -%ng be*)e"%!%n )%*i "e$en4%* ge!%. bening "%,e#,%+ A!-3i%$

m-#b%!e*i%/ !e*m%,&" Mycobacterium marianum/ Mycobacterium avium-

intracellulare/ Mycobacterium fortuitum )%n Mycobacterium gordonae/ !e$%.

)i"%i!"%n )eng%n in5e",i #,!e#%*!i&$%*+ In5e",i !&$%ng 4&g% bi,% )i,eb%b"%n


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#$e. be*b%g%i #*g%ni,me 4%m&*/ !e*m%,&" -%ng men-eb%b"%n

coccidioidomycosis, blastomycosis, kriptokokosis/ )%n sporotrichosis

e. E4ie+i3l37i

E3i)emi#$#gi #,!e#mie$i!i, memi$i"i bebe*%3% "een)e*&ng%n -%ng $&%,+

In,i)en #,!e#mie$i!i, .em%!#gen !%m3%"n-% men&*&n+ D%$%m ,eb&%.

3ene$i!i%n/ )i G$%,g#8/ S"#!$%n)i%/ )%*i 2>? "%,&, #,!e#mie$i!i, .em%!#gen

%"&! 3%)% %n%" )i b%8%. 1= !%.&n/ !e*)%3%! $%3#*%n 3en&*&n%n "e4%)i%n )%*i

@> ,%m3%i


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#*%ng )e8%,%+ Pen-eb%b 3%$ing &m&m )%*i #,!e#m-e$i!i, "%*en% in#"&$%,i

$%ng,&ng %)%$%. 3ene!*%,i )%*i $&"% )%n "#n!%min%,i be)%.+ F#"&, in5e",i

-%ng be*)e"%!%n 3%)% #,!e#mie$i!i, bi%,%n-% !e*4%)i 3%)% 3%,ien )eng%n

3en-%"i! 7%,"&$%* 3%*%.+

Faktor Host

F%"!#* host !e*&!%m% !e*$ib%! )%$%m 3e*!%.%n%n in5e",i -%ng be*)e"%!%n

"e )%$%m !&$%ng+ P%)% $%in ,i,i/ 5%"!#* host )%3%! mem3eng%*&.i in)i7i)&

&n!&" 3e*"emb%ng%n #,!e#mie$i!i,+ De5i,ien,i )%*i host -%ng men-eb%b"%n

b%"!e*emi% men)&"&ng 3engemb%ng%n #,!e#mie$i!i, .em%!#gen+ De5i,ien,i

host -%ng !e*$ib%! )%$%m in#"&$%,i $%ng,&ng )%*i #*g%ni,me )%n %!%&

3en-eb%*%n in5e",i )%*i )%e*%. -%ng be*)e"%!%n !e*.%)%3 in5e",i 4%*ing%n

$&n%" !e*&!%m% !e*$ib%! )%$%m "&*%ngn-% 3e*!%.%n%n in5e",i %8%$+ Tig%

"e$#m3#" 3%,ien )eng%n "e*en!%n%n -%ng 4%*%ng !e*.%)%3 in5e",i !&$%ng %"&!

%)%$%. me*e"% )eng%n %nemi% ,e$ ,%bi!/ 3en-%"i! g*%n&$#m%!#,% "*#ni,/ )%n

)i%be!e, me$$i!&,+ B%n-%" 5%"!#* ,i,!emi" )%n $#"%$ mem3eng%*&.i

"em%m3&%n .#,! &n!&" men)%3%!"%n *e,3#n -%ng e5e"!i5 !e*.%)%3 in5e",i )%n

3eng#b%!%n 'T%be$ II(+

Patologi

O*e3+&eli*i a-u*

O,!e#mie$i!i, %"&! m&n&$ ,eb%g%i ,&3&*%!i5/ %!%& mem3*#)&",i n%n%./

in5e",i )i,e*!%i )eng%n e)em%/ "#nge,!i 7%,"&$%*/ )%n !*#mb#,i, 3emb&$&.

)%*%. "ei$+ P%)% 3en-%"i! %"&! %8%$/ 3%,#"%n 7%,"&$%* "e !&$%ng men&*&n

#$e. in5e",i )%n me$&%, "e 4%*ing%n $&n%" ,e"i!%*n-%+ Ke!i"% 3%,#"%n )%*%.

me)&$e* )%n 3e*i#,!e%$ !e*g%ngg&/ )%3%! !e*ben!&" %*e% be,%* !&$%ng -%ng m%!i

',eC&e,!*%(+ N%m&n/ 4i"% ,ege*% )i#b%!i ,e%*% %g*e,i5 )eng%n %n!ibi#!i" )%n

m&ng"in )eng%n #3e*%,i/ #,!e#mie$i!i, %"&! )%3%! )i!%.%n ,ebe$&m !&$%ng

6


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men4%)i m%!i/ .%$ ini men4%)i !%n)% 3en-%"i! "*#ni, ,e)%ng be*"emb%ng+

Se!e$%. in5e",i !e*4%)i/ 4%*ing%n 5ib*#,% )%n ,e$;,e$ in5$%m%,i "*#ni, !e*ben!&"

)i ,e"i!%* 4%*ing%n g*%n&$%,i )%n !&$%ng m%!i+ Se!e$%. !e*in5e",i/ !e*4%)i

3en&*&n%n 3%,#"%n 7%,"&$%* O$e. "%*en% i!&/ !i)%" )%3%! mem3*#)&",i

*e,3#n in5$%m%,i -%ng e5e"!i5+ K#e",i,!en,i !e*in5e",i/ 4%*ing%n n#n7i%b$e )%n

*e,3#n host -%ng !i)%" e5e"!i5 men-eb%b"%n "*#ni,i!%, 3en-%"i! ini+

O,!e#mie$i!i, %"&!/ 4i"% !i)%" )i#b%!i ,e%*% e5e"!i5/ )%3%! men-eb%b"%n

3en-%"i! "*#ni, ,e3e*!i -%ng !e*$i.%! 3%)% "$ini, )%n .i,!#$#gi,+

Ne"*#,i, 4%*ing%n !&$%ng me*&3%"%n !%n)% 3en!ing )%*i #,!e#mie$i!i,+

T&$%ng -%ng m%!i )i,e*%3 "emb%$i #$e. %",i en9im -%ng )i3*#)&",i #$e.

4%*ing%n g*%n&$%,i be*"emb%ng )i 3e*m&"%%nn-%+ Re,#*3,i be*$%ng,&ng

3%$ing %8%$ )%n 3%$ing e3%! )i %n!%*% 4%*ing%n !&$%ng .i)&3 )%n ne"*#!i"+

i"% %*e% !&$%ng m%!i "ei$/ m%"% %"%n ,e3en&.n-% .%n&*/ meningg%$"%n

*#ngg% )ibe$%"%ngn-%+ T&$%ng "%$"%ne&, ne"*#!i" 3%)% #,!e#mie$i!i, $#"%$/

me,"i3&n $&%,/ bi%,%n-% )i,e*%3+ Bebe*%3% !&$%ng "#*!i"%$ -%ng m%!i !e*$e3%,

,e%*% be*!%.%3 )%*i !&$%ng .i)&3 &n!&" memben!&" ,eb&%. ,eC&e,!*&m+

Un,&*;&n,&* #*g%ni" )%$%m !&$%ng m%!i ,eb%gi%n be,%* !e*g%ngg& #$e. %",i

en9im 3*#!e#$i!i" -%ng )i3*#)&",i #$e. ,e$ 3e*!%.%n%n host / !e*&!%m%

m%"*#5%g %!%& $e&"#,i! 3#$im#*5#n&"$e%*+ K%*en% ,&3$%i )%*%. .i$%ng/ !&$%ng

m%!i m&n&$ $ebi. 3&!i. )%*i !&$%ng .i)&3+ Semen!%*% !&$%ng "%$"%ne&,

)i,e*%3 )eng%n e3%! )%n )%3%! ,eC&e,!*% %!%& .%n&* )%$%m 8%"!& )&%

,%m3%i !ig% mingg&/ !&$%ng "#*!i"%$ -%ng ne"*#!i" m&ng"in meme*$&"%n )&%

mingg& ,%m3%i en%m b&$%n &n!&" 3emi,%.%n+ Se!e$%. 3emi,%.%n $eng"%3

'3*#,e, -%ng )i,eb&! sequestration(/ !&$%ng m%!i ,e%*% 3e*$%.%n !e*"i"i, )%n

)i,e*%3+ T&$%ng -%ng m%,i. .i)&3 bi%,%n-% men4%)i #,!e#3#*#,i, ,e$%m%

in5e",i m%,i. %"!i5+ H%$ ini me*&3%"%n .%,i$ )%*i *e%",i in5$%m%,i )%n %!*#5i+

Pemben!&"%n !&$%ng b%*& me*&3%"%n "%*%"!e*i,!i" 3%!#$#gi, )%*i

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#,!e#mie$i!i,/ !e!%3i bi%,%n-% )i!em&"%n )i #,!e#mie$i!i, ,&b%"&! )%n "*#ni,+

O*e3+ieli*i K3ni

T%n)% 3%!#$#gi #,!e#mie$i!i, "*#ni, %)%$%. %)%n-% !&$%ng ne"*#!i"/

3emben!&"%n !&$%ng b%*&/ )%n e",&)%,i $e&"#,i! 3#$im#*5#n&"$e%* be*g%b&ng

)eng%n ,e4&m$%. be,%* $im5#,i!/ .i,!i#,i!/ )%n "%)%ng;"%)%ng 3$%,m% ,e$+

Te*ben!&" !&$%ng b%*& )%*i 5*%gmen -%ng m%,i. .i)&3 )%*i 3e*i#,!i&m )%n

en)#,!e&m )i 8i$%-%. in5e",i+ Memben!&" ,e$&b&ng 3emb&ng"&, !&$%ng -%ng

.i)&3/ )i"en%$ ,eb%g%i involucrum/ )i,e"i!%* !&$%ng m%!i )ib%8%. 3e*i#,!e&m+

nvolucrum !i)%" !e*%!&* )%n ,e*ing be*$&b%ng be*i,i n%n%. -%ng )%3%! m%,&"

"e )%$%m 4%*ing%n $&n%" ,e"i!%*n-% )%n %".i*n-% meng%$i* "e 3e*m&"%%n

"&$i!/ memben!&" ,in&, "*#ni,+ nvolucrum ,e%*% be*!%.%3 )%3%!

mening"%!"%n "e3%)%!%n )%n "e!eb%$%n &n!&" memben!&" ,eb%gi%n %!%&

,e$&*&. )%*i )i%3.i,i, b%*&+ Ni$%i "e3%)%!%n !&$%ng b%*& mening"%! ,e$%m%

bebe*%3% mingg& %!%& b&$%n/ ,e,&%i )eng%n &"&*%n !&$%ng )%n )&*%,i )%*i

in5e",i+

T&$%ng b%*& en)#,!e%$ m&ng"in be*"emb%ng )%n men-&mb%! ,%$&*%n

me)&$%+ Se!e$%. 3e*!%.%n%n host %!%& #3e*%,i 3eng%ng"%!%n ,eC&e,!*&m/

men-i,%"%n *#ngg% -%ng )%3%! !e*i,i )eng%n !&$%ng b%*&/ !e*&!%m% 3%)% %n%";

%n%"+ N%m&n/ 3%)% #*%ng )e8%,%/ *#ngg% )%3%! be*!%.%n .i)&3 %!%& )%3%!

)ii,i )eng%n 4%*ing%n 5ib*#,%/ -%ng m&ng"in be*.&b&ng%n )eng%n 3e*m&"%%n

"&$i! me$%$&i ,%$&*%n ,in&,+

@


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Te+uan ai S*ui E-4ei+en*al

Re,3#n in5$%m%,i &n!&" #,!e#mie$i!i, !e$%. men4%)i #b-e" 3en-e$i)i"%n+

P*#)&",i 3*#,!%g$%n)in;E !e$%. !e*b&"!i $ebi. !inggi ? ,%m3%i =0 "%$i 3%)%

!&$%ng -%ng !e*in5e",i )ib%n)ing"%n !&$%ng n#*m%$+ D%$%m ,!&)i )%*i .e8%n

)eng%n #,!e#mie$i!i,/ 3*#)&",i )%$%m 4&m$%. be,%* 3*#,!%g$%n)in be*!%ngg&ng

4%8%b %!%, *e,#*3,i !&$%ng )%n 3emben!&"%n ,eC&e,!*&m/ )%n 3eng#b%!%n

e",3e*imen!%$ 3%)% "e$ini )eng%n #,!e#mie$i!i, mengg&n%"%n n%!*i&m

,%$i,i$%! )i!&n4&""%n &n!&" meneg%. *e,#*3,i )%n 3en-e*%3%n !&$%ng+

Peng#b%!%n e",3e*imen!%$ #,!e#mie$i!i, 3%)% !i"&, )eng%n ib&3*#5en !e$%.

!e*b&"!i meng&*%ngi 3*#)&",i 3*#,!%g$%n)in )%$%m !&$%ng -%ng !e*in5e",i )%n

,e%*% be*,%m%%n meng&*%ngi "e$%in%n !&$%ng ,e%*% n-%!% )%n 3e*&b%.%n

*%)i#g*%5i/ !%n3% %)% 3e*&b%.%n )%$%m 4&m$%. b%"!e*i+ Men&*&! 3ene$i!i%n

*e,#*3,i !&$%ng %"ib%! me!%,!%!i" "%n"e*/ !%m3%"n-% $ebi. m&ng"in )ime)i%,i

#$e. bebe*%3% ,i!#"in )%n 5%"!#* 3e*!&mb&.%n/ !e*m%,&" tumor necrosis

factor )%n meng&b%. 5%"!#* 3e*!&mb&.%n %$5% )%n be!%/ )%n b&"%n #$e.


11/40

3*#,!%g$%n)in+

F%g#,i!#,i, -%ng e5e"!i5 !e$%. !e*b&"!i men4%)i 5%"!#* 3en!ing )%$%m

3e*!%.%n%n host 3%)% 3%,ien )eng%n #,!e#mie$i!i,+ Pengg&n%%n granulocyte-

macrophage colony-stimulating factor *e"#mbin%n/ 5%"!#* 3e*!&mb&.%n

)eng%n ,i5%! 3*#;5%g#,i!#,i, )%n %n!i;in5$%m%,i/ )i"#mbin%,i"%n )eng%n

3eng#b%!%n %n!ibi#!i" ,!%n)%* $ebi. e5e"!i5 )%*i3%)% 3engg&n%%n %n!ibi#!i"

,%4% )%$%m 3eng#b%!%n #,!e#mie$i!i, %"&! 3%)% e",3e*imen!%$ )i !i"&,+ D%$%m

,eb&%. 3ene$i!i%n 3%)% "e$ini/ !e"%n%n #",igen in!*%me)&$$% )i !&$%ng -%ng

!e*in5e",i $ebi. *en)%. )%*i3%)% )i !&$%ng n#*m%$ !e"%n%n #",igen =0

mmHg me*&,%" 5&ng,i 5%g#,i!#,i, n#*m%$+ D%$%m m#)e$ -%ng ,%m%/ !e*%3i

#",igen .i3e*b%*i" )i!&n4&""%n ,e%*% ,igni5i"%n '3 0/001( meng&*%ngi &ni!

3emben!&" "#$#ni )ib%n)ing"%n )eng%n ,%m3e$ #n!*#$ -%ng !i)%" )i!e*%3i

)%n ,%m3e$ #n!*#$ -%ng )i!e*%3i )eng%n %n!ibi#!i"+

Bebe*%3% 5%"!#* b%"!e*i !e$%. )i%"&i 3en!ing )%$%m 3%!#gene,i,

#,!e#mie$i!i,+ K%*en% 3%!#gen .%*&, meng"#$#ni,%,i 4%*ing%n !%*ge! &n!&"

mem&$%i in5e",i/ *e,e3!#* -%ng %)e"&%! )i3e*$&"%n &n!&" )%3%! me$%"&"%n

%)e,i "e !&$%ng/ "e m%!*i", e",!*%,e$&$%*/ )%n "e 3e*%ng"%! im3$%n me)i,+

Stafilokokus memi$i"i be*b%g%i 3*#!ein )%n g$i"#3*#!ein %)e,i -%ng be,%*

&n!&" me$e"%! 3%)% "#m3#nen !&$%ng+ F%"!#* 3en!ing )%$%m 3%!#gene,i,

#,!e#mie$i!i, %)%$%. 3emben!&"%n g$-#%$- ,e"i!%* #*g%ni,me in5e",i+

G$-#%$- ini me$in)&ngi #*g%ni,me )%*i %",i 5%g#,i! )%n meneg%.

,eb%gi%n be,%* %n!imi"*#b% &n!&" m%,&"+ B&"!i men&n4&""%n b%.8%

3e*m&"%%n m&%!%n neg%!i5 )%*i !&$%ng %!%& im3$%n $#g%m men-eb%b"%n %)e,i

b%"!e*i )%n 3emben!&"%n g$-#%$-+

:%*% $%in )i m%n% b%"!e*i meng.in)%*i 3e*!%.%n%n host )%n meng.%,i$"%n

in5e",i !&$%ng %)%$%. )eng%n men)%3%!"%n %",e, "e b%gi%n )%$%m ,e$+ H%$ ini

)i!&n4&""%n )eng%n %)%n-% staphylococci )i #,!e#b$%, )%n #,!e#,i! m%n&,i%

10


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)%$%m m#)e$ in 7i7#+ B%*&;b%*& ini/ ,eb&%. ,!&)i in 7i!*# men&n4&""%n b%.8%

#,!e#b$%,! -%ng m%!i %!%& ,e"%*%! m%m3& me$e3%,"%n b%"!e*i Staphylococcus

aureus -%ng m%,i. m%m3& mengin5e",i "emb%$i #,!e#b$%, m%n&,i% 3%)%

"&$!&*+ Tem&%n ini men%*i" "%*en% )%3%! be*"#n!*ib&,i 3%)% 3em%.%m%n

3%!#$#gi )%*i #,!e#mie$i!i,+

7. Manife*ai Klini

Tanda dan Gejala

An%";%n%" )eng%n #,!e#mie$i!i, .em%!#gen memi$i"i !%n)%;!%n)% in5e",i

%"&! !e*m%,&" )em%m/ i*i!%bi$i!%,/ $e!%*gi/ )%n !%n)%;!%n)% 3e*%)%ng%n $#"%$+

N%m&n/ )%$%m ,eb&%. ,!&)i 3%)% 6@ %n%"/ ?0 )%*i memi$i"i ge4%$% -%ng

,%m%*/ !e*m%,&" n-e*i 3%)% !&ng"%i %n!%*% )&*%,i 1 ,%m3%i = b&$%n )%3%!

)i,e*!%i 3ening"%!%n ,&.&+ An%";%n%" )eng%n #,!e#mie$i!i, .em%!#gen

bi%,%n-% memi$i"i 4%*ing%n $&n%" -%ng !i)%" !e*in5e",i -%ng memb&ng"&,

!&$%ng -%ng !e*in5e",i )%n m%m3& membe*i"%n *e,3#n 3e*!%.%n%n e5e"!i5

!e*.%)%3 in5e",i+ Sen)i bi%,%n-% !e*.in)%* )%*i in5e",i "e&%$i ,&)%. !e*4%)i

me!%5i,i, )iin!*%%3,&$%*/ ,e3e*!i -%ng )i!em&"%n )i b%gi%n 3*#",im%$ )%*i

*%)i&,/ .&me*&,/ %!%& 5em&*+

O*%ng )e8%,% )eng%n #,!e#mie$i!i, .em%!#gen 3*ime* %!%& *e"&*en

bi%,%n-% .%)i* )eng%n ge4%$% ,%m%* -%ng !e*)i*i )%*i n-e*i ,3e,i5i" )%n

)em%m )eng%n )&*%,i 1 ,%m3%i = b&$%n+ N%m&n/ ge4%$% "$ini, %"&! ,e3e*!i

)em%m/ menggigi$/ 3embeng"%"%n/ )%n e*i!em% 3%)% !&$%ng -%ng !e*$ib%!

"%)%ng;"%)%ng !e*$i.%!+ S&mbe* b%"!e*emi% m&ng"in )%*i in5e",i "&$i! "ei$

%!%& in5e",i -%ng $ebi. ,e*i&, ,e3e*!i en)#"%*)i!i, b%"!e*i %"&! %!%& ,&b%"&!+

O,!e#mie$i!i, .em%!#gen -%ng me$ib%!"%n b%i" !&$%ng 3%n4%ng %!%& 7e*!eb*%

%)%$%. "#m3$i"%,i )%*i 3engg&n%%n n%*"#b% ,&n!i"%n+

P%,ien )eng%n #,!e#m-e$i!i, "%*en% 5#"&, in5e",i -%ng be*)e"%!%n ,e*ing

11


13/40

.%)i* 3%)% !&$%ng -%ng !e*$#"%$i,i* )%n n-e*i ,en)i/ e*i!em%/ beng"%"/ )%n

)i,e"i!%* )%e*%. )*%in%,e )%*i !*%&m%/ #3e*%,i/ %!%& in5e",i $&"%+ T%n)%;!%n)%

b%"!e*emi% ,e3e*!i )em%m/ menggigi$/ )%n be*"e*ing%! )i m%$%m .%*i

m&ng"in %)% )%$%m 5%,e %"&! #,!e#mie$i!i, !e!%3i !i)%" !e*$i.%! )%$%m 5%,e

"*#ni,+

B%i" #,!e#mie$i!i, .em%!#gen )%n 5#"&, in5e",i -%ng be*)e"%!%n )%3%!

be*"emb%ng men4%)i "#n)i,i "*#ni,+ Ke.i$%ng%n !&$%ng $#"%$/ 3emben!&"%n

,eC&e,!*&m/ )%n ,$e*#,i, !&$%ng &m&m !e*4%)i+ D*%in%,e )%n %!%& 4%$&* ,in&,

3e*,i,!en ,e*ing )i!em&"%n be*)e"%!%n )eng%n )%e*%. in5e",i+ P%,ien bi%,%n-%

)%!%ng )eng%n n-e*i "*#ni, )%n )*%in%,e+ Dem%m *ing%n/ !ing"%! ,e)imen!%,i

e*i!*#,i! bi%,%n-% mening"%!/ mene*min"%n 3e*%)%ng%n "*#ni,/ !e!%3i 4&m$%.

$e&"#,i! )%*%. bi%,%n-% n#*m%$+ Pen-%"i! "*#ni, bi%,%n-% .%)i* b%i" 3*#g*e,i5

$%mb%! %!%&3&n n#n 3*#g*e,i5+ i"% ,%$&*%n ,in&, !e*,&mb%!/ 3%,ien m&ng"in

.%)i* )eng%n %b,e, $#"%$ )%n %!%& in5e",i 4%*ing%n $&n%" %"&!+

Studi Laboratorium

&m$%. $e&"#,i! m&ng"in mening"%! 3%)% "%,&, #,!e#mie$i!i, %"&!/ !e!%3i

,e*ing"%$i n#*m%$ )%$%m "%,&,;"%,&, "*#ni,+ Ting"%! ,e)imen!%,i e*i!*#,i!

bi%,%n-% mening"%! 3%)% "e)&% #,!e#mie$i!i, %"&! )%n "*#ni,/ )%n men&*&n

,e!e$%. 3eng#b%!%n -%ng be*.%,i$+ Ting"%! ,e)imen!%,i e*i!*#,i! bi%,%n-%

mening"%! ,ege*% ,e!e$%. )eb*i)emen! #3e*%!i5+ Ting"%! ,e)imen!%,i e*i!*#,i!

-%ng "emb%$i n#*m%$ ,e$%m% !e*%3i %)%$%. !%n)% 3*#gn#,i, -%ng b%i"+

N%m&n/ in!e*3*e!%,i )%*i 3ening"%!%n LED ,e%*% !e*&,;mene*&, ,e!e$%.

3e*%8%!%n .%*&, )i!e$i!i )eng%n .%!i;.%!i/ !e*&!%m% "e!i"% )i!em&"%n 3%)%

host #m3*#mi,e+ A".i*n-%/ !ing"%! ,e)imen!%,i e*i!*#,i! !i)%" &"&3 ,en,i!i5

&n!&" men-ing"i*"%n #,!e#m-e$i!i, %"&! %!%& "*#ni,+

Ting"%! :;*e%"!i5 3*#!ein %)%$%. in)e", in5$%m%,i $%in -%ng mening"%!

12


14/40

3%)% #,!e#m-e$i!i, %"&! )%n "*#ni, )%n 3en&*&n%n LED -%ng e3%! %)% 3%)%

3%,ien -%ng be*.%,i$ )i#b%!i+ D%$%m ,eb&%. ,!&)i )%*i %n%";%n%" )eng%n

#,!e#mie$i!i, %"&!/ !ing"%! :;*e%"!i5 3*#!ein )i!em&"%n men&*&n !%4%m ,e!e$%.

!ig% .%*i 3eng#b%!%n %n!ibi#!i" 3%)% 3%,ien )eng%n .%,i$ -%ng

meng&n!&ng"%n/ ,e)%ng"%n ni$%i -%ng $ebi. !inggi )i%m%!i 3%)% #*%ng )eng%n

"#m3$i"%,i+ Me,"i3&n !ing"%! :;*e%"!i5 3*#!ein m&ng"in me*&3%"%n

3%*%me!e* -%ng $ebi. ,en,i!i5 )ib%n)ing"%n )eng%n !ing"%! ,e)imen!%,i

e*i!*#,i!/ n#*m%$n-% -%ng !i)%" )%3%! )ig&n%"%n men-ing"i*"%n )i%gn#,i,

#,!e#mie$i!i, + &m$%. $e&"#,i!/ $%4& en)%3 )%*%./ )%n !ing"%! :;*e%!i7e

3*#!ein .%*&, )i3%n!%& 3%)% ,%%! m%,&" )%n ,e$%m% 3eng#b%!%n )%n !in)%"

$%n4&! 3%)% ,em&% 3%,ien )eng%n #,!e#mie$i!i,+ P%)% 3%,ien )eng%n

#,!e#mie$i!i, .em%!#gen %"&!/ 3%*%me!e* ini .%*&, )i&"&* ,e!i%3 mingg&+

N%m&n/ &n!&" 3enge!%.&%n "i!%/ !i)%" %)% in5#*m%,i )%$%m $i!e*%!&* mengen%i

5*e"&en,i 3eng&4i%n &n!&" 3%,ien )eng%n #,!e#mie$i!i, "*#ni,+ D%$%m

3*%"!e"n-%/ "%mi me$%"&"%n 3ene$i!i%n ,e!i%3 )&% mingg& ,e$%m% 3eng#b%!%n

%n!ibi#!i" )%n 3%)% %".i* 3eng#b%!%n+

Se4&m$%. !e, $%b#*%!#*i&m -%ng be*be)% .%*&, )i$%"&"%n 3%)% 3%,ien

)eng%n #,!e#mie$i!i, &n!&" mem%n!%& !#",i,i!%, #b%! '!ing"%! "*e%!inin ,e*&m

)%n !e, 5&ng,i .%!i(/ ,!%!&, gi9i '"%)%* ,e*&m %$b&min )%n total iron-binding

capacity(/ )%n "#m#*bi)i!%, 'mi,%$n-%/ "%)%* g$&"#,% )%*%. &n!&" 3%,ien

)eng%n )i%be!e,(+

Mikrobiologi

Di%gn#,i, )%n 3enen!&%n e!i#$#gi #,!e#mie$i!i, 3%)% !&$%ng 3%n4%ng

!e*g%n!&ng 3%)% i,#$%,i 3%!#gen )%$%m "&$!&* ,3e,imen )%*i $e,i !&$%ng/ )%*%./

%!%& %i*%n ,en)i+ P%)% 3%,ien )eng%n :ie*n-;M%)e* ,!%)i&m 1/ %!%&

.em%!#gen/ #,!e#mie$i!i,/ "&$!&* )%*i )%*%. %!%& %i*%n ,en)i -%ng 3#,i!i5

1=


15/40

)%3%! !i)%" )i$%"&"%n "e!i"% 3%)% *%)i#g*%5i !e*b&"!i #,!e#mie$i!i,+ Ke&%$i

#,!e#mie$i!i, .em%!#gen/ -%ng 3%)% "&$!&* )%*%. %!%& %i*%n ,en)i m&ng"in

)%3%! )i$%"&"%n/ )%n bi$% 3#,i!i5/ 3eng#b%!%n %n!ibi#!i" #,!e#mie$i!i, .%*&,

)i)%,%*"%n 3%)% ,!&)i ,en,i!i7i!%, )%*i "&$!&* !&$%ng )i%mbi$ 3%)% ,%%!

)eb*i)emen! %!%& )%$%m bi#3,i !&$%ng+ i"% mem&ng"in"%n/ "&$!&* ,3e,imen

.%*&, )i3e*#$e. ,ebe$&m %n!ibi#!i" )im&$%i+ N%m&n/ ,e%*% em3i*i,

3embe*i%n %n!ibi#!i )im&$%i ,ebe$&m "&$!&* ,3e,imen )i3e*#$e.+ D%$%m .%$

ini/ *e4imen em3i*i" .%*&, )i.en!i"%n ,e$%m% !ig% .%*i ,ebe$&m 3eng%mbi$%n

,%m3e$ &n!&" "&$!&*+ K&$!&* ,3e,imen )%*i ,%$&*%n ,in&, !i)%" )%3%!

)i%n)%$"%n &n!&" mem3*e)i",i #*g%ni,me -%ng %"%n )ii,#$%,i )%*i !&$%ng

-%ng !e*in5e",i+ N%m&n/ "#*e$%,i 3#,i!i5 !e$%. )i!em&"%n %n!%*% 3e*!&mb&.%n

Staphylococcus aureus 3%)% "&$!&* ,3e,imen )%*i ,%$&*%n ,in&, )%n 3%)%

"&$!&* !&$%ng+

Te"ni" mi"*#bi#$#gi "#n7en,i#n%$ bi%,%n-% )ig&n%"%n &n!&" )i%gn#,i,

#,!e#mie$i!i,+ N%m&n/ bebe*%3% 3en&$i, !e$%. mene!%3"%n b%.8%

mening"%!"%n !e"ni" &n!&" 3eng#$%.%n b%.%n 3&*&$en )%3%! meng.%,i$"%n

3e*,en!%,e -%ng $ebi. !inggi )%*i ,!*%in, -%ng !e*i,#$%,i+ Te"ni" lisis-

sentrifugasi !e$%. )i4e$%,"%n &n!&" mening"%!"%n ,en,i!i7i!%, 3%)% ,%m3$e

"&$!&* #,!e#mie$i!i,+ !olymerase chain reaction/ )i"en%$ ,eb%g%i !e"ni"

%m3$i5i"%,i gen/ !e$%. )ig&n%"%n )%$%m )i%gn#,i, in5e",i !&$%ng 3%)% 3%!#gen

-%ng ,&$i!/ ,e3e*!i ,e3e*!i Mycoplasma pneumoniae/ "rucella ,3e,ie,/

"artonella henselae/ )%n ,3e,ie, Mycobacterium TB )%n n#n!&be*&$#&,+

!olymerase chain reaction !e$%. men)e!e",i M-#b%!e*i&m !&be*&$#,i, )i

formaldehida solution-fi#ed / ,%m3e$ 4%*ing%n;3%*%5in -%ng %)% 3%)% 3%,ien

)eng%n !ott disease+

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Temuan radiografi

P%)% #,!e#m-e$i!i, .em%!#gen/ 3e*&b%.%n *%)i#g*%5i bi%,%n-%

mene*min"%n 3*#,e, )e,!*&"!i5 )%n !e*4%)i ,e!i)%"n-% 2 mingg& ,e!e$%.

3*#,e, in5e",i+ Pe*&b%.%n %8%$ -%ng !e*4%)i %)%$%. 3embeng"%"%n 4%*ing%n

$&n%"/ 3eneb%$%n )%n %!%& 3ening"%!%n 3e*i#,!e%$ )%n #,!e#3eni% 5#"%$+

Se!i)%"n-% ?0 ,%m3%i >? )%*i m%!*i", !&$%ng .%*&, )i.%n&*"%n ,ebe$&m*%)i#g*%5i men&n4&""%n 3e*&b%.%n $i!i"+ Pe*&b%.%n $i!i" -%ng !e*!&n)%

be*"%i!%n )eng%n ,&b%"&! )%n #,!e#m-e$i!i, "*#ni,+ B&"!i 3e*b%i"%n

*%)i#g*%5i m&ng"in $%m% m&n&$ ,e!e$%. 3em&$i.%n "$ini,/ b%."%n "e!i"%

3%,ien mene*im% !e*%3i %n!imi"*#b% -%ng !e3%!+ P%)% #,!e#m-e$i!i, 5#"&,

in5e",i -%ng be*)e"%!%n/ 3e*&b%.%n *%)i#g*%5i bi%,%n-% $ebi. *ing%n ,e*ing

)i"%i!"%n )eng%n/ !em&%n *%)i#g*%5i n#n,3e,i5i" $%inn-% )%n meme*$&"%n

"#*e$%,i "$ini, -%ng e*m%! &n!&" men)%3%!"%n )i%gn#,!i" -%ng *e$e7%n+

$omputed tomography %",i%$ m&ng"in mem%in"%n 3e*%n )%$%m

)i%gn#,i, #,!e#mie$i!i,+ Pening"%!%n "e3%)%!%n !&$%ng ,&m,&m !e*4%)i )i %8%$

3e*4%$%n%n in5e",i/ )%n g%, in!*%me)&$$% !e$%. )i$%3#*"%n 3%)% 3%,ien )eng%n

#,!e#mie$i!i, .em%!#gen+ $omputed tomography )%3%! memb%n!&

mengi)en!i5i"%,i"%n !&$%ng -%ng ne"*#!i" )%n men&n4&"%n "e!e*$ib%!%n

4%*ing%n $&n%" ,e"i!%*n-%+ S%$%. ,%!& "e&n!&ng%n )%*i ini %)%$%. %)%n-%

1?


17/40

scatter phenomenon/ -%ng .%)i* "e!i"% g%mb%*%n $#g%m m&n&$ )i)%$%m %!%&

)e"%! !&$%ng -%ng !e*in5e",i )%n meng.%,i$"%n "e.i$%ng%n *e,#$&,i g%mb%*+

Peni!*%%n *e,#n%n,i m%gne!i" !e$%. )i%"&i ,eb%g%i m#)%$i!%, be*g&n%

&n!&" men)i%gn#,% "ebe*%)%%n )%n in5e",i m&,"&$#,"e$e!%$+ Re,#$&,i

3eni!*%%n *e,#n%n,i m%gne!i" be*g&n% &n!&" membe)%"%n %n!%*% !&$%ng )%n

in5e",i 4%*ing%n $&n%"/ -%ng ,e*ing men4%)i m%,%$%. )eng%n mengg&n%"%n

*%)i#n&"$i)%+ Ti)%" ,e3e*!i *%)i#n&"$i)%/ magnetic resonance imaging !i)%"

be*g&n% &n!&" 3eme*i",%%n ,e$&*&. !&b&.+ &g%/ 3%)% 3engg&n%%n $#g%m

im3$%n meng.%,i$"%n 5#"&, %*!e5%"/ ,e.ingg% meng&*%ngi "&%$i!%, g%mb%*+

Screening %8%$ )eng%n magnetic resonance imaging bi%,%n-% !e*)i*i )%*i T1

)%n T2+ D%$%m ,eb&%. ,!&)i T1/ g%mb%*%n e)em% be*8%*n% ge$%3 )%n $em%"

be*8%*n% !e*%ng+ Se)%ng"%n T2/ ,eb%$i"n-%+ G%mb%*%n ".%, #,!e#mie$i!i,

%"&! %)%$%. )%e*%. $#"%$ -%ng %bn#*m%$ )%*i ,&m,&m !&$%ng )eng%n in!en,i!%,

,in-%$ men&*&n 3%)% T1 )%n in!en,i!%, ,in-%$ mening"%! 3%)% g%mb%* T2+

P%,% !*%&m% be)%. %!%& 4%*ing%n 3%*&! )%*i ,&m,&m !&$%ng )ig%mb%*"%n

,eb%g%i 8i$%-%. in!en,i!%, ,in-%$ men&*&n 3%)% T1 )%n !i)%" %)% 3e*&b%.%n

3%)% g%mb%* T2+ S%$&*%n ,in&, )i$i.%! ,eb%g%i )%e*%. in!en,i!%, ,in-%$ !inggi

mem%n4%ng )%*i ,&m,&m !&$%ng )%n me$%$&i 4%*ing%n $&n%" )%n me$%$&i "&$i!

3%)% g%mb%* T2+ Se$&$i!i, )i3%n)%ng ,eb%g%i )%e*%. ,in-%$ )i5&, %n!%*%

g%mb%* T1 )%*i 4%*ing%n $&n%"/ )eng%n 3ening"%!%n ,in-%$ !e*$i.%! 3%)%

g%mb%* T2 )%*i )%e*%. -%ng ,%m%+ Magnetic resonance imaging memi$i"i

,en,i!i7i!%, -%ng ,%ng%! !inggi )%n ,3e,i5i,i!%, &n!&" )i%gn#,i, #,!e#mie$i!i,+

S%n *%)i#n&"$i)% )%3%! )i$%"&"%n "e!i"% )i%gn#,i, #,!e#mie$i!i, men4%)i

%mbig& %!%& &n!&" memb%n!& meng&"&* ,e4%&. m%n% 3e*%)%ng%n !&$%ng )%n

4%*ing%n $&n%"+ Se%*% &m&m/ !i)%" 3e*$& &n!&" me$%"&"%n ,%n ini &n!&"

)i%gn#,i, #,!e#mie$i!i, !&$%ng 3%n4%ng+ Me"%ni,me ,eben%*n-% be$&m 4e$%,+

P%)% %%m-technetium polifosfat ,%n men)em#n,!*%,i"%n 3ening"%!%n

16


18/40

%"&m&$%,i i,#!#3 )i bi)%ng 3ening"%!%n %$i*%n )%*%. )%n 5#*m%,i *e%"!i5 3%)%

!&$%ng b%*&+ Scan technetium-%%m m&ng"in neg%!i5 &n!&" 3%,ien )eng%n

#,!e#mie$i!i, "%*en% !e*4%)i 3en&*&n%n %$i*%n )%*%. "e %*e% -%ng !e*in5e",i+

R%)i#5%*m%,i $%in -%ng )ig&n%"%n &n!&" e7%$&%,i #,!e#mie$i!i, me$i3&!i

g%$$i&m i!*%!e+ G%$$i&m menem3e$ 3%)% !*%n,5e*in/ -%ng b##* )%*i %$i*%n

)%*%. "e )%e*%. 3e*%)%ng%n+ G%$$i&m ,%n 4&g% men&n4&""%n 3ening"%!%n

,e*%3%n i,#!#3 )i )%e*%. $e&"#,i! 3#$im#*5#n&"$e%* )%n m%"*#5%g

!e*"#n,en!*%,i )%n !&m#* g%n%,+ Se4%" ,%n g%$$i&m i!*%!e !i)%" men&n4&""%n

)e!i$ !&$%ng )eng%n b%i"/ ,e*ing"%$i ,&$i! &n!&" membe)%"%n %n!%*% !&$%ng )%n

3e*%)%ng%n 4%*ing%n $&n%" 3e*b%n)ing%n )eng%n scan technetium-%%m )%3%!

memb%n!& &n!&" men-e$e,%i"%n 3en-e$e,%i%n ini+ G%$$i&m i!*%!e 4&g%

)i!em&"%n men&m3&" )i )%e*%. !e*in5e",i )%n !i)%" !e*in5e",i+ K%*en%

g%$$i&m !e*%"&m&$%,i )i )%e*%. 3e*%)%ng%n/ memi$i"i ,en,i!i7i!%, !inggi )%n

,3e,i5i,i!%, -%ng *en)%. &n!&" )i%gn#,i, #,!e#mie$i!i,+

In)i&m $e&"#,i! ,%n %)%$%. %$%! $%in -%ng be*g&n% &n!&" men)i%gn#,i,

#,!e#mie$i!i, %"&! )%n "*#ni,+ In)i&m $e&"#,i! ,%n %"%n 3#,i!i5 .ingg% @0

3%)% 3%,ien )eng%n #,!e#mie$i!i, %"&! N%m&n/ ,en,i!i7i!%, $ebi. *en)%.

&n!&" 3%,ien )eng%n #,!e#mie$i!i, 7e*!eb*%$ "*#ni,+

Me,"i3&n "%mi !i)%" menem&"%n 3e)#m%n 3engg&n%%n "$ini, ,!&)i

*%)i#g*%5i )%$%m $i!e*%!&*/ "%mi me*e"#men)%,i"%n b%.8% *%)i#g*%5i 3#$#,

)ib&%! ,e!i%3 "%$i )i)&g% #,!e#m-e$i!i, %"&! %!%& "*#ni, "%*en% 3eme*i",%%n

ini ,%ng%! ,e)e*.%n%/ e"#n#mi, )%n bi%,%n-% e5e"!i5+ MRI .%*&, )i$%"&"%n

4i"% )i%gn#,i, )i*%g&"%n+ $omputed tomography scan )%3%! )ig&n%"%n &n!&"

memb%n!& 3e*en%n% be)%. #,!e#mie$i!i, b%i" %"&! )%n "*#ni,+

%. Tea4i

Peng#b%!%n -%ng !e3%! &n!&" #,!e#mie$i!i, me$i3&!i )*%in%,e -%ng

mem%)%i/ )eb*i)emen! men-e$&*&./ #b$i!e*%,i *&%ng m%!i/ 3e*$in)&ng%n $&"%/

1>


19/40

)%n %"&3%n %n!imi"*#b% ,3e,i5i"+ i"% 3%,ien %)%$%. host -%ng "#m3*#mi,e/

3e*$& )i$%"&"%n &3%-% &n!&" mem3e*b%i"i %!%& meng&*%ngi )e5e" 3%)% host +

Pe*.%!i%n ,e%*% ".&,&, )ibe*i"%n &n!&" n&!*i,i/ 3*#g*%m be*.en!i me*#"#"/

)%n 3engen)%$i%n 3en-%"i! !e*!en!& ,e3e*!i )i%be!e,+ Deng%n )emi"i%n/

)i$%"&"%n &,%.% &n!&" mening"%!"%n ,!%!&, "e,e.%!%n gi9i/ )%n 3emb&$&.

)%*%. )%*i 3%,ien &n!&" men)%3%!"%n 3e*%8%!%n -%ng #3!im%$ )%*i 3en-%"i!

-%ng men)%,%*i %3%3&n+ I)e%$n-%/ ,!%n)%* 3e*%8%!%n me$ib%!"%n 3en)e"%!%n

!im !e*m%,&" ,3e,i%$i, 3en-%"i! men&$%*/ )#"!e* be)%. 3$%,!i"/ )%n )#"!e*

"#n,&$!%,i $%inn-% -%ng ,e,&%i+

Pengobatan Antibiotik

B%n-%" %,3e" 3eng#b%!%n %n!ibi#!i" #,!e#mie$i!i, be$&m ,e3en&.n-%

)i,e$i)i"i+ Bi%,%n-% )&*%,i 3eng#b%!%n )i ,eb%gi%n be,%* !%.%3%n

#,!e#m-e$i!i, ':ie*n-;M%)e* T%.%3%n 1/ =/ )%n


20/40

"$in)%mi,in/ *i5%m3i,in/ "#!*im#",%9#$/ )%n 5$*#C&in#$#ne, 'T%be$ III(+

K$in)%mi,in/ %n!ibi#!i" $in#,%mi)e %"!i5 !e*.%)%3 ,eb%gi%n be,%* b%"!e*i

g*%m 3#,i!i5/ memi$i"i bi#%7%i$%bi$i!%, -%ng ,%ng%! b%i" )%n ,%%! ini )ibe*i"%n

,e%*% #*%$ ,e!e$%. 3eng#b%!%n in!*%7en% %8%$ )%$%m )&*%,i 1 ,%m3%i 2

mingg&+ Line9#$i)/ %n!ibi#!i" #*%$ )%n in!*%7en% %"!i5 !e*.%)%3 methicillin-

resistant staphylococcus/ !e$%. !e*b&"!i e5e"!i5 &n!&" meng#b%!i in5e",i ,e*i&,/

!e*m%,&" #,!e#mie$i!i,+ Te*%3i #*%$ )eng%n "&in#$#n &n!&" #*g%ni,me g*%m

neg%!i5 ,%%! ini ,e)%ng )ig&n%"%n 3%)% 3%,ien )e8%,% )eng%n #,!e#mie$i!i,+

K&in#$#n gene*%,i "e)&% 'i3*#5$#%in )%n #5$#%in( memi$i"i %"!i7i!%,

-%ng b&*&" !e*.%)%3 ,3e,ie, Streptococcus/ ,3e,ie, Enterococcus/ )%n b%"!e*i

%n%e*#bi $%inn-%+ K&in#$#n gene*%,i "e!ig% '$e7#5$#%in )%n g%!i5$#",%,in(

memi$i"i %"!i7i!%, -%ng ,%ng%! b%i" !e*.%)%3 ,3e,ie, Streptococcus !e!%3i

memi$i"i %"&3%n minim%$ 3%)% b%"!e*i %n%e*#bi"+ Gene*%,i "eem3%!

"&in#$#n !*#7%5$#%in memi$i"i %"&3%n -%ng ,%ng%! b%i" )%*i ,3e,ie,

Streptococcus )%n #*g%ni,me %n%e*#bi"+ T*#7%5$#%in )i,e!&4&i .%n-% &n!&"

3eng#b%!%n *%8%! in%3 )%n .%*&, )ig&n%"%n )eng%n .%!i;.%!i "%*en%/ )%$%m

"%,&, -%ng 4%*%ng/ )%3%! men-eb%b"%n !#",i,i!%, .%!i -%ng ,e*i&,+ T%" ,%!&

3&n )%*i "&in#$#n memi$i"i %"!i5i!%, -%ng !e*3e*%-% 3%)% ,3e,ie,

Enterococcus& K&in#$#n -%ng !e*,e)i% ,%%! ini men&n4&""%n %"&3%n 7%*i%be$

Staphylococcus aureus )%n Staphylococcus epidermidis/ )%n *e,i,!en,i #b%!

g#$#ng%n "&in#$#n gene*%,i "e)&% )%n "e!ig% !e$%. mening"%!+ Un!&" b%"!e*i

methicillin-sensitif Staphylococcus aureus .%*&, )ig&n%"%n )eng%n %n!ibi#!i"

#*%$ -%ng $%in ,e3e*!i "$in)%mi,in %!%& %m3i,i$in;,&$b%"!%m+ K%*en% %b,#*b,i

-%ng ,%ng%! b%i"/ "&in#$#n )%3%! )ibe*i"%n ,e%*% #*%$ ,ege*% ,e!e$%. 3%,ien

m%m3& memin&m #b%!+ D#,i, !inggi )%*i "e$%, "&in#$#n %n!ibi#!i" !e$%.

)i$%3#*"%n me*&,%" !&$%ng *%8%n %*!i"&$%* 3%)% .e8%n m&)%/ !em&%n ini

!e$%. membe*i"%n bebe*%3% "e".%8%!i*%n mengen%i 3engg&n%%n 4%ng"%

1


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3%n4%ng )%*i #b%! ini 3%)% b%-i )%n %n%";%n%"+ O$e. "%*en% i!&/ )%$%m

,eb%gi%n be,%* "e%)%%n/ 3%,ien %n%" !i)%" b#$e. )ibe*i"%n "e$%, "&in#$#n

%n!ibi#!i"+

Ke3&!&,%n &n!&" mengg&n%"%n #*%$ )%*i3%)% %n!ibi#!i" 3%*en!e*%$ .%*&,

)i)%,%*"%n 3%)% .%,i$ ,en,i!i7i!%, mi"*##*g%ni,me/ "e3%!&.%n 3%,ien/

"#n,&$!%,i "e3%)% %.$i 3en-%"i! men&$%*/ )%n 3eng%$%m%n )#"!e* be)%.+

K#mbin%,i %n!ibi#!i" 3%*en!e*%$ )%n #*%$ -%ng !e$%. )ig&n%"%n )%$%m

bebe*%3% ,i!&%,i+ Ri5%m3i,in #*%$ ,%%! ini )ig&n%"%n ,eb%g%i #b%! "#mbin%,i

3%*en!e*%$ )%n #*%$ &n!&" in5e",i Staphylococcus aureus+ N%m&n ,e.%*&,n-%

3engg&n%%n ini !i)%" )i$%"&"%n ,e%*% !&ngg%$ "%*en% )%3%! mem3e*e3%!

*e,i,!en,i "&m%n+

Me,"i3&n %"!i7i!%, ,e*&m b%"!e*i,i)%$ !e$%. )i"%i!"%n )eng%n .%,i$ -%ng

meng&n!&ng"%n )%$%m 3eng#b%!%n #,!e#mie$i!i, .em%!#gen 3%)% &m&mn-%/

n%m&n !i)%" 3e*$& mem%n!%& $e7e$ ,e*&m b%!e*i,i)%$ "%*en% "eb%n-%"%n

"eg%g%$%n 3eng#b%!%n m&ng"in "%*en% "&*%ngn-% )eb*i)emen! -%ng

mem%)%i )%*i3%)% %n!ibi#!i" -%ng !i)%" %)e"&!%+ M&ng"in 3e*$& mem%n!%&

$e7e$ ,e*&m b%!e*i,i)%$ 3%)% 3%,ien )eng%n #*g%ni,me *e$%!i5 *e,i,!en %!%&

&n!&" meng&"&* e5e"!i7i!%, !e*%3i %n!ibi#!i" #*%$+

I)e%$n-%/ 3eng#b%!%n #,!e#mie$i!i, .%*&, )i)%,%*"%n 3%)% .%,i$ "&$!&*

!&$%ng+ Se!e$%. ,3e,imen "&$!&* )i3e*#$e. )eng%n %*% bi#3,i !&$%ng %!%&

,e$%m% )eb*i)emen!/ *e4imen %n!imi"*#b% 3%*en!e*%$ )im&$%i &n!&"

me$in)&ngi 3%!#gen "$ini, -%ng )i&*ig%i+ Se!e$%. #*g%ni,me )ii)en!i5i"%,i/

3eng#b%!%n )%3%! )im#)i5i"%,i ,e,&%i )eng%n ,en,i!i7i!%, mi"*##*g%ni,me

-%ng !e*i,#$%,i 'T%be$ III(+ N%m&n/ "e!i"% 3%,ien ,%"i! %"&!/ 3eng#b%!%n

%n!ibi#!i" !i)%" b#$e. )i!&n)% &n!&" men&ngg& )eb*i)emen! !&$%ng+

Pengobatan Antibiotik Berdasarkan Stadium

S!%)i&m;1 #,!e#mie$i!i, 'G%mb%*+ 1( 3%)% %n%";%n%" bi%,%n-% )%3%!

20


22/40

)i#b%!i )eng%n %n!ibi#!i" !&ngg%$ "%*en% !&$%ng %n%";%n%" ,%ng%! 7%,"&$%*

)%n memi$i"i *e,3#n -%ng e5e"!i5 !e*.%)%3 in5e",i+ S!%)i&m;1 #,!e#mie$i!i,

3%)% #*%ng )e8%,% 'G%mb%*+ 2( $ebi. !%.%n !e*.%)%3 !e*%3i )%n bi%,%n-%

)i#b%!i )eng%n %n!ibi#!i" )%n in!e*7en,i #3e*%!i5+ P%,ien )i#b%!i )eng%n !e*%3i

%n!imi"*#b% 3%*en!e*%$ -%ng ,e,&%i ,e$%m% < mingg&/ !e*.i!&ng )%*i !e*%3i

ini,i%,i %!%& )%*i )eb*i)emen! #3e*%,i !e*%".i*+ i"% m%n%4emen me)i, %8%$

g%g%$ )%n 3%,ien ,e%*% "$ini, !e*g%ngg& #$e. in5e",i be*&$%ng/ !&$%ng )%n

%!%& )eb*i)emen! 4%*ing%n $&n%" )i3e*$&"%n !e*%3i %n!ibi#!i" $%gi ,e$%m% <

mingg&+

21


23/40

22


24/40

Te*%3i %n!ibi#!i" #*%$ )%3%! )ig&n%"%n &n!&" meng#b%!i ,!%)i&m;1

#,!e#mie$i!i, 3%)% %n%";%n%"+ N%m&n/ )%$%m "eb%n-%"%n ,!&)i )%$%m

$i!e*%!&*/ %n%";%n%" %8%$n-% mene*im% 1 .ingg% 2 mingg& !e*%3i %n!ibi#!i"

3%*en!e*%$ ,ebe$&m be*&b%. "e !e*%3i #*%$+ ,!%)i&m;2 #,!e#mie$i!i, 'Gb*+ =(/

%n!ibi#!i" 4%ng"% 3en)e" bi%,%n-% )i3e*$&"%n+ D%$%m ,eb&%. ,!&)i )i m%n%

3engg&n%%n %n!ibi#!i" ,e$%m% 2 mingg& )ibe*i"%n ,%%! )eb*i)emen! )%*i

"#*!e", )%n men%ng"&3 4%*ing%n $&n%"+ O,!e#m-e$i!i, )%3%! )i!%.%n .%m3e*

100 3%)% host A )%n > 3%)% host B+

2=


25/40

K%mi me$%"&"%n 3eng#b%!%n 3%)% 3%,ien ,!%)i&m;= %!%& < )%*i

#,!e#mie$i!i, )eng%n !e*%3i %n!ibi#!i" ,e$%m%


26/40

Terapi Supresif Antibiotik

Ke!i"% 3eng#b%!%n #3e*%!i5 #,!e#mie$i!i, !i)%" )%3%! )i$%"&"%n/ !e*%3i%n!ibi#!i" ,&3*e,i5/ bi%,%n-% )ibe*i"%n ,e%*% #*%$/ bi%,%n-% )ibe*i"%n &n!&"

mengen)%$i"%n 3en-%"i! )%n &n!&" meneg%. 3e*"emb%ng%n 3en-%"i!+

I)e%$n-%/ #b%! ,&3*e,i5 .%*&, memi$i"i bi#%7%i$%bi$i!%, -%ng b%i"/ memi$i"i

!#",i,i!%, *en)%./ )%n )%3%! menemb&, !&$%ng ,e%*% mem%)%i+ Re4imen

,&3*e,i5 .%*&, be*)%,%*"%n .%,i$ "&$!&*+ Mi"*##*g%ni,me 3en-eb%b .%*&,

*en!%n !e*.%)%3 %n!ibi#!i" %!%& %n!ibi#!i" )%3%! )ig&n%"%n &n!&" ,&3*e,i5+

Te*%3i ,&3*e,i5 &n!&" in5e",i )i ,e"i!%* im3$%n #*!#3e)i !e$%. )i3e$%4%*i ,e%*%

e",!en,i5+ Ri5%m3i,in ')%$%m "#mbin%,i )eng%n %n!ibi#!i" $%inn-%(/ %,%m

5&,i)i/ #5$#",%,in/ )%n "#!*im#",%9#$ !e$%. )ibe*i"%n/ ,e$%m% 6 ,%m3%i

b&$%n/ &n!&" 3%,ien -%ng memi$i"i in5e",i )i,e"i!%* im3$%n+ Se!e$%.

3eng.en!i%n 3eng#b%!%n/ !e*)%3%! 26 )%*i = 3%,ien '6>( -%ng )i#b%!i

)eng%n #!*im#%9#$e !i)%" meng%$%mi "e"%mb&.%n in5e",i ,e$%m% 5#$$#8

&3/ 11 '??( )%*i 20 3%,ien -%ng )i#b%!i )eng%n %,%m 5&,i)i )%n *i5%m3i,in/

2?


27/40

)%n 11 '?0( )%*i 20 )&% )i#b%!i )eng%n *i5%m3i,in )%n #5$#%in+ Keg%g%$%n

3eng#b%!%n )i,eb%b"%n #$e. in5e",i -%ng mene!%3 %!%& *e,i,!en,i !e*.%)%3

%n!ibi#!i"+ E5e"!i5i!%, !e*%3i ,&3*e,i5 m&ng"in men-eb%b"%n 3e*3%n4%ng%n

8%"!& b%"!e*i &n!&" be*e3$i"%,i %!%& m&ng"in "%*en% )i!e"%nn-% %",i

g$-#%$- !e*.%)%3 ,e$+ E5e"!i5i!%, 3eng#b%!%n ,&3*e,i5 #,!e#m-e$i!i, 3%)%

!&$%ng 3%n4%ng !%n3% im3$%n )i !em3%! be$&m )i!en!&"%n+

Te*%3i ,&3*e,i5 bi%,%n-% )ibe*i"%n ,e$%m% 6 b&$%n+ i"% !e*)%3%! in5e",i

be*&$%ng ,e!e$%. 3eng.en!i%n !e*%3i/ b%*& )i$%"&"%n !e*%3i ,&3*e)i5 ,e&m&*

.i)&3+

Pengobatan Operatif

M%n%4emen #3e*%!i5 #,!e#mie$i!i, bi,% ,%ng%! men%n!%ng+ P*in,i3;&n!&"

meng#b%!i ,e!i%3 in5e",i be*$%"& &n!&" 3eng#b%!%n in5e",i 3%)% !&$%ng+

P*in,i3;3*in,i3 ini me$i3&!i )*%in%,e -%ng %)e"&%!/ )eb*i)emen! $&%, )%*i

,em&% 4%*ing%n ne"*#!i"/ #b$i!e*%,i *&%ng m%!i ')e%) ,3%e(/ 3e*$in)&ng%n

!e*.%)%3 4%*ing%n $&n%" -%ng %)e"&%!/ )%n mem3e*b%i"i e5e"!i5i!%, %$i*%n

)%*%.+ Peng#b%!%n #3e*%!i5 3%)% host -%ng "#m3*#mi,e b%."%n $ebi.

men%n!%ng+ G%ngg&%n 5&ng,i#n%$ -%ng )i,eb%b"%n #$e. 3en-%"i!/ #3e*%,i

*e"#n,!*&",i/ )%n %"ib%! me!%b#$i" !e*.%)%3 !e*%3i -%ng %g*e,i5

mem3eng%*&.i 3emi$i.%n 3%,ien &n!&" me$%"&"%n 3eng#b%!%n+ Te*"%)%ng/

3*#,e)&* -%ng )i3e*$&"%n &n!&" me*ing%n"%n 3en-%"i! !e*,eb&! )%3%!

men-eb%b"%n .i$%ngn-% 5&ng,i/ !&ng"%i/ %!%& "e.i)&3%n )%*i host + O$e.

"%*en% i!&/ 3eng#b%!%n #3e*%!i5 ,!%n)%* #,!e#mie$i!i, !i)%" )%3%! )i$%$&"%n

3%)% ,em&% "%,&, !e*,eb&! )%n 3%)% bebe*%3% 3%,ien -%ng !e*%n%m 4i8%n-%

3eng#b%!%n *%)i"%$ )%3%! )i3i$i. ,e3e*!i %m3&!%,i %!%& mengg&n%"%n !e*%3i

%n!ibi#!i ,&3*e,i+

26


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ebridemen Tulang

T&4&%n )eb*i)emen! %)%$%. meningg%$"%n 4%*ing%n -%ng ,e.%! )%n $%-%"+

Deb*i)emen! !&$%ng )i$%"&"%n ,%m3%i !e*)%3%! !i!i";!i!i" 3en)%*%.%n %!%&

paprika sign+ N%m&n/ b%."%n "e!i"% ,em&% 4%*ing%n ne"*#!i" !e$%. )i

)eb*i)emen! ,e%*% !e3%!i/ 4%*ing%n -%ng !e*,i,% )i3e*!imb%ng"%n !e$%.

!e*"#n!%min%,i+ B%*&;b%*& ini/ !e$%. )i$%"&"%n 3ene$i!i%n 3%)% !in)%"%n

#3e*%,i )eb*i)emen ,e%*% $&%, 3%)% 3%,ien -%ng n#*m%$ )%n 3%,ien

"#m3*#mi,e/ )im%n% host "#m3*#mi,e -%ng )i#b%!i ,e%*% *e,e",i m%*gin%$

'-%i!& )eng%n $e%*%ne m%*gin ? mm( memi$i"i "e"%mb&.%n -%ng $ebi.

!inggi )%*i #*%ng n#*m%$+ Men&*&! 3en&$i, ,!&)i !e*,eb&!/ *e,e",i ,e%*% $&%,

!%m3%"n-% 4%&. $ebi. 3en!ing 3%)% "#m3*#mi,e host / ,e)%ng"%n *e,e",i

m%*4in%$ m&ng"in )%3%! )i!e*im% 3%)% .#,! -%ng n#*m%$+

!ekonstruksi efek pada Tulang dan Manajemen ead Spa"e

Deb*i)emen! -%ng %)e"&%! )%3%! meningg%$"%n )e5e" -%ng be,%* 3%)%

!&$%ng/ -%ng )i,eb&! ,eb%g%i dead space+ R&%ng ini %)%$%. m%,%$%. "%*en%

7%,"&$%*i,%,in-% -%ng b&*&" -%ng me*&3%"%n 3*e)i,3#,i,i &n!&" in5e",i

mene!%3+ M%n%4emen -%ng !e3%! )%*i ,e!i%3 dead space -%ng )i,eb%b"%n #$e.

)eb*i)emen! .%*&, )%3%! meneg%. in5e",i )%n men4%g% in!eg*i!%, *%ng"%+

T&4&%n )%*i m%n%4emen dead space %)%$%. &n!&" mengg%n!i"%n !&$%ng -%ng

m%!i )%n 4%*ing%n 3%*&! )eng%n 4%*ing%n 7%,"&*%*i,%,i -%ng !%.%n $%m%+

'raft %ng"#" !&$%ng )eng%n 7%,"&$%*i,%,i !e$%. !e*b&"!i ,&",e, &n!&"

mengi,i )e%) ,3%e !e*,eb&!+ 'raft ini bi%,%n-% )i3e*#$e. )%*i 5ib&$% %!%&

i$i&m+ Men&!&3 flaps )eng%n 4%*ing%n $#"%$ %!%& 4%*ing%n beb%, 4&g% )%3%!

)ig&n%"%n &n!&" mengi,i dead space+ Te"ni" %$!e*n%!i5 %)%$%. )eng%n

menem3%!"%n graft !&$%ng %ne$$#&, )ib%8%. 4%*ing%n $#"%$ %!%& bi$% 3e*$&

)%3%! )i!%mb%."%n !*%n,5e* 4%*ing%n+ Pe*en%n%%n 3*% #3e*%,i ,e%*% .%!i;.%!i

2>


29/40

,%ng%! 3en!ing 3%)% 3%,ien -%ng memi$i"i %)%ng%n !&$%ng %ne$$#&,

!e*b%!%,+ (pen graft %ne$$#&, !%n3% 4%*ing%n $&n%" be*g&n% %3%bi$% !*%n,5e*

4%*ing%n b&"%n$%. ,&%!& 3i$i.%n )%n flaps 4%*ing%n $#"%$ !i)%" mem%)%i+

ntibiotic-impregnated acrylic beads )%3%! )ig&n%"%n &n!&"

men,!e*i$"%n )%n meme$i.%*% dead space ,e%*% ,emen!%*%+ "eads bi%,%n-%

)i.i$%ng"%n )%$%m 8%"!& 2;< mingg& )%n )ig%n!i )eng%n graft !&$%ng

"%n,e$&,+ An!ibi#!i" -%ng 3%$ing &m&m )ig&n%"%n )%$%m beads %)%$%.

7%n"#mi,in/ !#b*%m-in/ )%n gen!%mi,in+ Ting"%! 3en%.%n%nn-% !e*.%)%3

#,!e#mie$i!i, be*"i,%* )%*i ?? 3%)% ,!&)i ?< 3%,ien/ 6 3%)% ,!&)i


30/40

3%,ien !i)%" meme*$&"%n 3eng#b%!%n !%mb%.%n %!%& split-graft skin -%ng

!eb%$ ,e!e$%. ,e"i!%* 20 .%*i 3eng#b%!%n )eng%n !e"%n%n neg%!i5+ M%n5%%!

,i,!em 7%"&m ,%ng%! men4%n4i"%n N%m&n/ &n!&" 3enge!%.&%n "i!%/ !i)%" %)%

&4i "$ini, !e*"#n!*#$ -%ng )%3%! menen!&"%n "ebe*.%,i$%n )%n *i,i"# 3%)%

3%,ien )eng%n #,!e#mie$i!i,+ P%*% 3en&$i, )%*i ,%$%. ,%!& ,!&)i "%,&,

me$%3#*"%n b%.8% ,i,!em 7%"&m memi$i"i 3#!en,i &n!&" 3e*"emb%ng%n

in5e",i $&"% %n%e*#b+

Stabilisasi Tulang

i"% !e*)%3%! "e!i)%",!%bi$%n 3%)% !&$%ng )i !em3%! in5e",i/ 3%,!i"%n

&n!&" meng%mbi$ !in)%"%n g&n% men%3%i ,!%bi$i!%, )eng%n 3$%!e,/ ,*e8,/

rods )%n %!%& 5i%!#* e",!e*n%$+ Fi",%,i e",!e*n%$ $ebi. )i,&"%i )%*i3%)%

5i",%,i in!e*n%$ "%*en% memi$i"i "een)e*&ng%n men4%)i in5e",i ,e"&n)e* )i

me)&$% )%n men-eb%* men4%)i in5e",i $&%,+ 5i",%,i e",!e*n%$ I$i9%*#7

mem&ng"in"%n *e"#n,!*&",i )e5e" ,e%*% ,egmen!%$ )%n *e,i"# in5e",i non-

unions men4%)i ,&$i!+ Me!#)e ini )i)%,%*"%n 3%)% !e"ni" )i,!*%",i

#,!e#gene,i, )im%n% #,!e#!#m- )ib&%! )i )%e*%. me!%3.i,i%$ !&$%ng ,e%*%

be*!%.%3 &n!&" mengi,i )e5e" 3%)% !&$%ng+ Te"ni" I$i9%*#7 )ig&n%"%n &n!&"

"%,&,;"%,&, #,!e#mie$i!i, ,&$i! "e!i"% ,!%bi$i,%,i )%n 3em%n4%ng%n !&$%ng

)i3e*$&"%n+ Me!#)e ini 4&g% )%3%! )ig&n%"%n &n!&" meng"#m3*e,i non-

unions )%n &n!&" mem3e*b%i"i malunions+ D%$%m ,!&)i )im%n% !e"ni" ini

)ig&n%"%n/ *%!%;*%!% )%3%! men%.%n #,!e#mie$i!i, be*"i,%* %n!%*% >? 3%)% 2@

3%,ien )%n 100 3%)% 11 3%,ien+

Pelindung untuk #aringan lunak

Pe*$in)&ng%n 4%*ing%n $&n%" -%ng %)e"&%! )i3e*$&"%n &n!&" men%.%n

#,!e#mie$i!i,+ De5e" "ei$ 3%)% 4%*ing%n $&n%" )%3%! )i!&!&3i )eng%n split skin

2


31/40

graft -%ng !eb%$+ Se"%*%ng ini )e5e" be,%* 3%)% 4%*ing%n $&n%" %!%&

3emb&ng"&, 4%*ing%n $&n%" -%ng in%)e"&%!/ flaps #!#! $#"%$ )%n 5$%3,

7%,"&$%*i,%,i #!#! )%3%! )i$%"&"%n 3%)% ,!%)i&m;1 )%n ,!%)i&m;2+ T*%n,5e*

)%*i 5$%3, #!#! $#"%$ )%n 5$%3, 7%,"&$%*i,%,i #!#! mem3e*b%i"i $ing"&ng%n

-%ng bi#$#gi, )eng%n memb%8% ,&3$%i )%*%. -%ng 3en!ing &n!&" me"%ni,me

3e*!%.%n%n host / 3embe*i%n %n!ibi#!i"/ )%n 3en-emb&.%n !&$%ng )%n 4%*ing%n

$&n%"+

F$%3, #!#! $#"%$ )%n mi"*#7%,"&$e* ,e*!% 5$%3, mi"*#7%,"&$e* !&ngg%$

!e$%. )ig&n%"%n )%$%m "#mbin%,i )eng%n %n!ibi#!i" )%n )eb*i)emen!+ Ting"%!

3en%.%n%n !e*.%)%3 #,!e#mie$i!i, -%ng be*"i,%* %n!%*% 0 )%$%m ,!&)i ==

3%,ien/ 100 )%$%m ,!&)i 1@ 3%,ien+

P%)% %".i*n-%/ 3en-emb&.%n )eng%n %*% ,e"&n)e* .%*&, ".%8%!i* bi$%

4%*ing%n 3%*&! -%ng mengi,i )e5e" m&ng"in %"%n men4%)i %7%,&$%*+

Pen&!&3%n $&"% .%*&, )i$%"&"%n bi$% mening"in"%n+

Me,"i3&n !e*)%3%! "em%4&%n %n!ibi#!i" )%n 3eng#b%!%n #3e*%!i5/

#,!e#mie$i!i, !e!%3 ,&$i! &n!&" )i#b%!i+ B%"!e*i )%3%! men%3%i !&$%ng me$%$&i

%$i*%n )%*%./ )%*i 5#"&, in5e",i -%ng be*)e"%!%n/ ,eb%g%i %"ib%! )%*i !*%&m%

!emb&,/ %!%& )%*i in!e*7en,i #3e*%!i5+ T&$%ng -%ng ne"*#,i, !e*4%)i )i%8%$/

meng%*%. "e 3*#,e, "*#ni, )%n mem3e*,&$i! &!&" "em&ng"in%n e*%)i"%,i

"&m%n+ A)%n-% 4%*ing%n )eng%n 7%,"&$%*i,%,i -%ng b&*&"/ 3e*$e"%!%n b%"!e*i

)i,!*&"!&* !&$%ng )%n im3$%n/ )%n *e3$i"%,i b%"!e*i -%ng $%mb%! ,em&%n-%

be*"#n!*ib&,i men-eb%b"%n in5e",i -%ng mene!%3+ Peng#b%!%n -%ng !e3%!

&n!&" #,!e#mie$i!i, !e*)i*i )%*i !e*%3i %n!imi"*#b% -%ng %)e"&%! )%n

)eb*i)emen! #3e*%!i5 ,em&% !&$%ng )%n 4%*ing%n $&n%" -%ng ne"*#!i"+

Peng#b%!%n %n!ibi#!i" .%*&, )i!en!&"%n be*)%,%*"%n .%,i$ "&$!&* )%n

mengi)en!i5i"%,i ,en,i!i7i!%,n-% !e*.%)%3 %n!ibi#!i"+ Peng#b%!%n ,e*ing

me$ib%!"%n "#mbin%,i )%*i %n!ibi#!i"+ Peng#b%!%n #3e*%!i5 .%*&, men%"&3

=0


32/40

)eb*i)emen!/ #b$i!e*%,i dead space/ 3e*$in)&ng%n 4%*ing%n $&n%" -%ng

%)e"&%!/ 3em&$i.%n ,&3$%i )%*%./ )%n ,!%bi$i,%,i+ In!e*%",i -%ng b%i" %n!%*%

be*b%g%i ,3e,i%$i, '%.$i be)%. #*!#3e)i/ )#"!e* be)%. 3$%,!i" )%n 3emb&$&.

)%*%./ )%n ,3e,i%$i, 3en-%"i! men&$%*( ,%ng%! 3en!ing &n!&" mening"%!"%n

mene4emen 3en-%"i! ini+

B. Tea4i 3-i7en %i4e5ai- 4aa 3*e3+ieli*i

a. Se8aa% Hi4e5ai-

Te*%3i #",igen .i3e*b%*i" )i3e*"en%$"%n 3e*!%m% "%$i #$e. Be.n"e 3%)%

!%.&n 1=0+ S%%! i!& !e*%3i #",igen .i3e*b%*i" .%n-% )ibe*i"%n "e3%)% 3%*%

3en-e$%m &n!&" meng.i$%ng"%n ge4%$% 3en-%"i! )e"#m3*e,i '$aisson*s

disease( -%ng !imb&$ %"ib%! 3e*&b%.%n !e"%n%n &)%*% ,%%! men-e$%m/

,e.ingg% 5%,i$i!%, !e*%3i !e*,eb&! ,eb%gi%n be,%* .%n-% )imi$i"i #$e. bebe*%3%

*&m%. ,%"i! TNI AL )%n *&m%. ,%"i! -%ng be*.&b&ng%n )eng%n

3e*!%mb%ng%n.Te*%3i .i3e*b%*i" m&ng"in b%*& ,ege$in!i* #*%ng -%ng mengen%$n-%+ Di

In)#ne,i% ,en)i*i/ !e*%3i #",igen .i3e*b%*i" 3e*!%m% "%$i )im%n5%%!"%n 3%)%

!%.&n 160 #$e. L%"e,$% -%ng be"e*4%,%m% )eng%n RSAL D*+ R%me$%n/

S&*%b%-%+ Hingg% ,%%! ini 5%,i$i!%, !e*,eb&! me*&3%"%n -%ng !e*be,%* )i

In)#ne,i%+ A)%3&n bebe*%3% *&m%. ,%"i! $%in -%ng memi$i"i 5%,i$i!%, !e*%3i

#",igen .i3e*b%*i" %)%$%. 'RS PT A*&n Ae./ RSAL D* Mi)i-%!#,/ T%n4&ng

Pin%ng/ RSAL D* Min!#.%*)4# %"%*!%/ RS Pe*!%min% :i$%%3/ RS P%n!i

%$&-# S#$#/ L%"e,$% TNI AL S&*%b%-%/ RSU S%ng$%. Den3%,%*/ RS

Pe*!%min% B%$i"3%3%n/ RS G&n&ng en%ng M%n%)#/ RSU M%"%,%*/ RSAL

H%$#ng Amb#n/ RS Pe!*#me* S#*#ng(.

D%,%* )%*i !e*%3i .i3e*b%*i" ,e)i"i! b%n-%" meng%n)&ng 3*in,i3 5i,i"%+

Te#*i T#*ie$$i -%ng men)%,%*i !e*%3i )ig&n%"%n &n!&" menen!&"%n !e"%n%n

&)%*% 1 %!m %)%$%. >60 mmHg+ D%$%m !e"%n%n &)%*% !e*,eb&! "#m3#,i,i

=1


33/40

&n,&*;&n,&* &)%*% -%ng !e*"%n)&ng )i )%$%mn-% meng%n)&ng Ni!*#gen 'N2(

> )%n O",igen 'O2( 21+ D%$%m 3e*n%5%,%n "i!% 3&n )emi"i%n+ P%)%

!e*%3i .i3e*b%*i" #",igen *&%ng%n -%ng )i,e)i%"%n meng%n)&ng O",igen 'O 2(

100+ Te*%3i .i3e*b%*i" 4&g% be*)%,%*"%n !e#*i 5i,i"% )%,%* )%*i .&"&m;

.&"&m D%$!#n/ B#-$e/ :.%*$e, )%n Hen*-+

Se)%ng"%n 3*in,i3 -%ng )i%n&! ,e%*% 5i,i#$#gi, %)%$%. b%.8% !i)%"

%)%n-% O2 3%)% !ing"%! ,e$&$e* %"%n men-eb%b"%n g%ngg&%n "e.i)&3%n 3%)%

,em&% #*g%ni,me+ O",igen -%ng be*%)% )i ,e"e$i$ing !&b&. m%n&,i% m%,&" "e

)%$%m !&b&. me$%$&i %*% 3e*!&"%*%n g%,+ F%,e;5%,e *e,3i*%,i )%*i 3e*!&"%*%n

g%, !e*)i*i )%*i 5%,e 7en!i$%,i/ !*%n,3#*!%,i/ &!i$i,%,i )%n )i55&,i+ Deng%n

"#n)i,i !e"%n%n #",igen -%ng !inggi/ )i.%*%3"%n m%!*i", ,e$&$e* -%ng

men#3%ng "e.i)&3%n ,&%!& #*g%ni,me men)%3%!"%n "#n)i,i -%ng #3!im%$.

Te*%3i #",igen .i3e*b%*i" 'HBOT( %)%$%. !e*%3i me)i, )im%n% 3%,ien

)%$%m ,&%!& *&%ng%n meng.i,%3 #",igen !e"%n%n !inggi '100( %!%& 3%)%

!e"%n%n b%*#me!e* !inggi 'hyperbaric chamber (+ K#n)i,i $ing"&ng%n )%$%m

HBOT be*!e"%n%n &)%*% -%ng $ebi. be,%* )ib%n)ing"%n )eng%n !e"%n%n )i

)%$%m 4%*ing%n !&b&. '1 ATA(+ Ke%)%%n ini )%3%! )i%$%mi #$e. ,e,e#*%ng 3%)%

8%"!& men-e$%m %!%& )i )%$%m *&%ng &)%*% -%ng be*!e"%n%n !inggi 'RUBT(

-%ng )i*%n%ng b%i" &n!&" "%,&, 3en-e$%m%n m%&3&n 3eng#b%!%n 3en-%"i!

"$ini,+ In)i7i)& -%ng men)%3%! 3eng#b%!%n HBOT %)%$%. ,&%!& "e%)%%n

in)i7i)& -%ng be*%)% )i )%$%m *&%ng%n be*!e"%n%n !inggi '1 ATA( )%n

be*n%5%, )eng%n #",igen 100+ Te"%n%n %!m#,5e* 3%)% 3e*m&"%%n %i* $%&!

,ebe,%* 1 %!m+ Se!i%3 3en&*&n%n "e)%$%m%n == "%"i/ !e"%n%n %"%n n%i" 1 %!m+

Se#*%ng %.$i !e*%3i .i3e*b%*i"/ L%",m% D*+ )*+ M+ G&*i!n# S/ SMHS/ DEA

-%ng !e$%. men)%$%mi i$m& #",igen .i3e*b%*i" )i Pe*%ni, ,e$%m% ? !%.&n

men4e$%,"%n b%.8% !e*)%3%! )&% 4eni, )%*i !e*%3i .i3e*b%*i"/ e5e" me"%ni"

)%n 5i,i#$#gi,+ E5e" 5i,i#$#gi, )%3%! )i4e$%,"%n me$%$&i me"%ni,me #",igen

-%ng !e*$%*&! 3$%,m%+ Peng%ng"&!%n #",igen "e 4%*ing%n mening"%! ,ei*ing

=2


34/40

)eng%n 3ening"%!%n #",igen !e*$%*&! )%$%m 3$%,m%+ B%."%n/ "i%n 3#3&$e*n-%

".%,i%! )%n m%n5%%! !e*%3i ini/ 3em%"%i%nn-% !e$%. ,em%"in me$&%, ,eb%g%i

!e*%3i "eb&g%*%n !&b&. ,e*!% &n!&" "e%n!i"%n ,eb%g%i !e*%3i -%ng be*!&4&%n

membe*i"%n e5e" !%m3i$ %8e! m&)%+

5. O-i7en %i4e5ai-

O",igen %)%$%. ,&%!& g%, -%ng me*&3%"%n &n,&* 7i!%$ )%$%m 3*#,e,

me!%b#$i,me ,e$&*&. ,e$ !&b&.+ A)%n-% "e"&*%ng%n #",igen )%3%!

men-eb%b"%n "em%!i%n 4%*ing%n )%n meng%n%m "e.i)&3%n ,e,e#*%ng+

Te!%3i !i)%" b%n-%" #*%ng -%ng !%.&/ ,e$%in )%$%m 3*#,e, 3e*n%5%,%n )%n

me!%b#$i,me/ #",ig%n 4&g% memi$i"i 3e*%n )%$%m 3emben!&"%n "#$%gen )%n

3e*b%i"%n 4%*ing%n ,e.ingg% 3embe*i%n #",igen -%ng )%3%! memb%n!& )%$%m

3*#,e, 3en-emb&.%n $&"% m%&3&n )%$%m 3*#,e, %n!i 3en&%%n&

Se%*% &m&m/ !e*%3i #",igen .i3e*b%*i" 'HBOT J H-3e*b%*i #-gen

!.e*%3-( me*&3%"%n ,&%!& me!#)% 3eng#b%!%n )im%n% 3%,ien )ibe*i"%n

3e*n%3%,%n #",igen m&*ni '100( 3%)% !e"%n%n &)%*% -%ng )&% .ingg% !ig%

"%$i $ebi. be,%* )%*i3%)% !e"%n%n &)%*% %!m#,5e* n#*m%$/ -%i!& 1 %!m '>60

mmHg(+ Ke%)%%n ini )%3%! )i%$%mi #$e. ,e,e#*%ng 3%)% 8%"!& men-e$%m

%!%& be*%)% )%$%m *&%ng%n &)%*% be*!e"%n%n !inggi '.-3e*b%*i .%mbe*(

-%i!& ,&%!& *&%ng "e)%3 &)%*% !e*b&%! )%*i 3e*%ng"%! "e*%, -%ng m%m3&

)ibe*i"%n !e"%n%n $ebi. be,%* )%*i 1 %!m '*&%ng "#m3*e,i( be,e*!% ,&mbe*

#",igen )%n ,i,!em 3en-%$&*%nn-% "e )%$%m *&%ng *e"#m3*e,i !e*,eb&!+

D%$%m "#n)i,i n#*m%$/ #",igen )ib%8% #$e. ,e$ )%*%. me*%. "e,e$&*&.

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)ib%8% #$e. ,e$ )%*%. me*%. mening"%! .ingg%


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Hi3e*b%*i" #",igen !e*%3i 'HBOT( memi$i"i me"%ni,me )eng%n

mem#)&$%,i ni!*i! #",i)e 'NO( 3%)% ,e$ en)#!e$+ P%)% ,e$ en)#!e$ ini HBOT

4&g% mening"%!"%n in!e*me)ie! 7%,"&$e* en)#!e$ g*#8!. 5%!#* 'VEGF(+

Me$%$&i ,i"$&, K*eb, !e*4%)i 3ening"%!%n NADH -%ng memi& 3ening"%!%n

5ib*#b$%,!+ Fib*#b$%,! -%ng )i3e*$&"%n &n!&" ,in!e,i, 3*#!e#g$i"%n )%n

be*,%m% )eng%n VEGF %"%n mem%& "#$%gen ,in!e,i, 3%)% 3*#,e,

*em#)e$ing/ ,%$%. ,%!& !%.%3%n )%$%m 3en-emb&.%n $&"%.

O",igen .i3e*b%*i" %)%$%. ,&%!& %*% 3eng#b%!%n )im%n% 3%,ien

meng.i*&3 #",igen m&*ni '100( 3%)% !e"%n%n &)%*% $ebi. be,%* )%*i 3%)%

!e"%n%n &)%*% %!m#,5e* n#*m%$+ Peng#b%!%n #",igen .i3e*b%*i" ini/

be*3eng%*&. 3%)% 3engi*im%n #",igen ,e%*% ,i,!emi" )im%n% !e*4%)i

3ening"%!%n 2 ,%m3%i = "%$i $ebi. be,%* )%*i 3%)% %!m#,5i* bi%,%+ Me"%ni,me

)i %!%, be*.&b&ng%n )eng%n ,%$%. ,%!& m%n5%%! &!%m% HBOT -%i!& &n!&"

+ound healing + P%)% b%gi%n $&"% !e*)%3%! b%gi%n !&b&. -%ng meng%$%mi

e)em% )%n in5e",i+ Di b%gi%n e)em% ini !e*)%3%! *%)i"%$ beb%, )%$%m 4&m$%.

-%ng be,%*+ D%e*%. e)em% ini meng%$%mi "#n)i,i .i3#;#",igen "%*en%

.i3#3e*5&,i+ Pening"%!%n 5ib*#b$%,! ,eb%g%im%n% !e$%. )i,ingg&ng

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!e*,eb&!+ %)i$%. "#n)i,i )%e*%. $&"% !e*,eb&! men4%)i .i3e*7%,"&$%*/

.i3e*,e$&$e* )%n .i3e*#",i%+ Deng%n 3em%3%*%n #",igen !e"%n%n !inggi/

!e*4%)i 3ening"%!%n IFN;/ i;NOS )%n VEGF+ IFN; men-eb%b"%n TH;1

mening"%! -%ng be*3eng%*&. 3%)% B;e$$ ,e.ingg% !e*4%)i 3enging"%!%n Ig;G+

Deng%n mening"%!n-% Ig;G/ e5e" 5%g#,i!#,i, $e&"#,i! 4&g% %"%n mening"%!+

Se.ingg% )%3%! )i,im3&$"%n b%.8% 3%)% $&"%/ HBOT be*5&ng,i men&*&n"%n

in5e",i )%n e)em%+

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100/ !e"%n%n 2 = A!m+ T%.%3 ,e$%n4&!n-% )i$%n4&!"%n )eng%n 3eng#b%!%n

decompresion sickness& M%"% %"%n !e*4%)i "e*&,%"%n 4%*ing%n/ 3en-emb&.%n

=


36/40

$&"%/ .i3#",i% ,e"i!%* $&"%+ K#n)i,i ini %"%n memi& mening"%!n-%

5ib*#b$%,!/ ,in!e,% "#$%gen/ *%,i# RNADNA/ 3ening"%!%n leukosit killing /

,e*!% %ngi#gene,i, -%ng men-eb%b"%n ne#7%,"&$%*i,%,i 4%*ing%n $&"%+

Kem&)i%n %"%n !e*4%)i 3ening"%!%n )%n 3e*b%i"%n %$i*%n )%*%.

mi"*#7%,"&$%*+ Den,i!%, "%3i$e* mening"%! ,e.ingg% )%e*%. -%ng meng%$%mi

i,"emi% %"%n meng%$%mi reperfusi+ Seb%g%i *e,3#n/ %"%n !e*4%)i 3ening"%!%n

NO .ingg% < ? "%$i )eng%n )ii*ingi 3embe*i%n #",igen .i3e*b%*i" 2;= ATA

,e$%m% 2 4%m+ H%,i$n-% 3&n &"&3 mem&%,"%n/ -%i!& 3en-emb&.%n 4%*ing%n

$&"%+ Te*%3i ini 3%$ing b%n-%" )i$%"&"%n 3%)% 3%,ien )eng%n )i%be!e, me$$i!&,

)im%n% memi$i"i $&"% -%ng ,&"%* ,emb&. "%*en% b&*&"n-% 3e*5&,i 3e*i5e*

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3%$ing &!%m% %)%$%. ,ebe$&m !e*%3i 3%,ien .%*&, men4%$%ni 3eme*i",%%n

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37/40

3en)e"%!%n m&$!i)i,i3$in+ %$%&3&n #3e*%,i )eb*i)emen )%n 3eng#b%!%n

)eng%n %n!ibi#!i" !e$%. )i$%"&"%n/ !e*%3i memb&!&."%n 8%"!& -%ng $%m% )%n

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"%*en% i!&/ %".i*;%".i* ini )i"emb%ng"%n !e*%3i %)4&7%n! &n!&" !e*%3i

#,!e#m-e$i!i,+ Te*%3i #",igen .i3e*b%*i" %)%$%. ,%$%. ,%!& !e*%3i %)4&7%n!

-%ng 3%$ing 3#!en,i%$ )%n -%ng !e*,e*ing )ig&n%"%n ,eb%g%i %)4&7%n! 3%)%

!e*%3i #,!e#m-e$i!i,+ Te*%3i HBO mening"%!"%n !e"%n%n #",igen 4%*ing%n/

!&$%ng )%n 4%*ing%n $&n%" -%ng meng%$%mi 3en-emb&.%n %"ib%! i,"emi"+

Me"%ni,me HBO )%$%m 3eng#b%!%n #,!e#mie$i!i, %)%$%.

1+ Mening"%!"%n !e"%n%n #",igen 3%)% 4%*ing%n

2+ Mening"%!"%n me"%ni,me 5%g#,i! $e&"#,i! 3%)% !&$%ng )%n $&"% )eng%n

!e"%n%n #",igen *en)%.

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ne&*#7%,"&$%*i,%,i 3%)% )%e*%. -%ng meng%$%mi "em%!i%n 4%*ing%n/

3emb&$&. )%*%n %!%& 4%*ing%n $&n%"


38/40

#3e*%,i meng.i$%ng"%n 4%*ing%n -%ng m%!i 3%)% !&$%ng -%ng !e*in5e",i n%m&n

HBO mem3e*b%i"i *e,3#n .#,! )eng%n memb&%! $ing"&ng%n $ebi.

meng&n!&ng"%n &n!&" memb&n&. $e&"#,i! #",i)%!i5/ ne&*#7%,"&$%*i,%,i )%n

*e,#*,3,i !&$%ng -%ng meng%$%mi i,"emi" )%n !e*,in5e",i+ Se$i%n i!& !e*%3i

HBO mening"%!"%n !*%n,3#*!%,i )%n men%mb%."%n "em%n4&*%n !e*%3i

%n!ibi#!i" "%*en% 3embe*i%n %n!ibi#!i" %"%n !e*.%mb%! 4i"% !e*)%3%! %*e% -%ng

meng%$%mi .i3#",i%.

Se%*% g%*i, be,%* 3em%"%i%n )%n me"%ni,me #",igen .i3e*b%*i" )%$%m

3*#,e, 3en-emb&.%n $&"% )%3%! )i4e$%,"%n ,eb%g%i be*i"&! Hi3#",i% 3%)%

$&"% )%3%! )i"#*e",i )eng%n !e*%3i #",igen -%ng be*7%*i%,i )%*i 3em%"%i%n

in!%$%,i #",igen


39/40

DA/TAR P)STAKA

1+ D%b#7 GD+ O,!e#m-e$i!i,+ In :%n%$e ST/ Be%!- H+ :%m3be$$, #3e*%!i7e

#!!.#3%e)i,+ 11!. e)i!i#n+ USA M#,b- 200@+

2+ Mi$$e* MD+ Re7ie8 #5 #*!.#3%e)i,+ ? !. e)i!i#n+ P.i$%)e$3.i% S%&n)e*,

E$,e7ie* 200@+

=+ S#$#m#n L/ %*8i" D/ N%-%g%m S+ A3$e-, ,-,!em #5 #*!.#3%e)i, %n)

5*%!&*e,+ !. e)i!i#n+ UK H#))e* A*n#$) 2010+


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>+ :.en :E/ S.i. ST/ F& TH/ %ng / %ng :+ H-3e*b%*i #-gen !.e*%3- in

!.e !*e%!men! #5 .*#ni *e5*%!#*- #,!e#m-e$i!i, % 3*e$imin%*- *e3#*!+

T%i8%n De3%*!men! #5 !*%&m% ,&*ge*- :.%ng G&ng Mem#*i%$ H#,3i!%$

2002+

@+ G#me, D/ P%*ei*% M/ Be!!en#&! F+ O,!e#m-e$i!i, %n #7e*7ie8 #5

%n!imi*#bi%$ !.e*%3-+ B*%9i$ BPS 201=+

+ N%)eem M/ N%)eem S/ M%.m##) KT+ D*&g !.e*%3- in #,!e#m-e$i!i,+ L%.#*e

De3%*!men! #5 3.%*m%- $%.#*e #$$ege 5#* 8#men &ni7e*,i!- 2010+

10+ Ei) A/ Be*b%*i EF+ O,!e#m-e$i!i, *e7ie8 #5 3%!.#3.-,i#$#g-/ )i%gn#,!i,

m#)%$i!ie, %n) !.e*%3e&!i #3!i#n,+ USA Me) Lib%n 2012+

pengaruh hiperbarik oksigen terapi terhadap osteomielitis (dr. hisnindarsyah, se., m.kes.)

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