IRAMA SIRKADIAN PADA STROKE AKUT

CIRCADIAN RHYTHM IN ACUTE STROKE

Abstract

Latar Belakang: Irama sirkadian mempengaruhi perilaku dan hampir setiap fungsi fisiologis manusia. Stroke dapat mengganggu irama sirkadian sampai jangka waktu tertentu. Tujuan: Mengetahui perubahan pola irama sirkadian pada stroke akut di Manado. Metode: Penelitian kohort deskriptif di RSUP Prof. dr. R.D. Kandou, Manado bulan Desember 2015-Februari 2016. Subjek dibagi menjadi kelompok stroke iskemik dan stroke hemoragik. Perubahan irama sirkadian dinilai dengan melihat perubahan tekanan darah sistolik dan diastolik, denyut nadi, dan glukosa darah dalam 72 jam pertama perawatan. Hasil: Didapatkan 35 subjek (23 stroke iskemik dan 12 stroke hemoragik). Kenaikan tekanan sistolik dan diastolik pada stroke iskemik dan hemoragik mencapai puncaknya pada pukul 04.00. Tekanan darah sistolik menurun pada pukul 20.00 dan diastolik menurun lebih awal, pada pukul 08.00. Peningkatan rerata denyut nadi mencapai puncaknya pada pukul 16.00 dan menurun pada pukul 00.00 untuk kedua kelompok. Didapatkan peningkatan rerata kadar glukosa darah pada pukul 20.00 yang menurun pada pukul 08.00 untuk kedua kelompok. Diskusi: Pola diurnal dan nokturnal irama sirkadian untuk tekanan darah dan kadar glukosa darah masih terlihat tetapi nilai lonjakannya lebih tinggi daripada pola normal. Denyut nadi tidak mengalami perubahan berarti dibandingkan dengan pola normal. Umumnya irama sirkadian kembali normal setelah stroke melewati masa akut.

Kata kunci : irama sirkadian, stroke akut,  tekanan darah, nadi, glukosa darah.

ABSTRACT

Background: Circadian rhythm affects human behavior and almost all physiological functions. Stroke could disrupt the circadian rhythm until a certain period. Aim To learn the changes of circadian rhythm in acute stroke in Manado. Method: Descriptive cohort study conducted in R.D. Kandou hospital in Manado in December 2015-February 2016. Subjects were divided to ischemic stroke and hemorrhagic stroke groups. Changes in circadian rhythm was assessed by measuring the changes in systolic and diastolic blood pressures, heart rate, and blood glucose level within the first 72 hours of admission. Result: There were 35 subjects (23 ischemic stroke and 12 hemorrhagic stroke). The increase of systolic and diastolic blood pressures in ischemic and hemorrhagic stroke reached their peak at 04.00 am. Systolic blood pressure decreased at 08.00 pm while diastolic blood pressure decreased earlier at 08.00 am. The increase in average heart rate reached its peak at 04.00 pm and decreased at 00.00 am in both groups. There was an increase in the average blood glucose level at 08.00 pm that decreased at 08.00 am in both groups. Discussion: Diurnal-nocturnal pattern of circadian rhythm for blood pressure and blood glucose was still present but the spike was higher than normal. In general, the circadian rhythm returned to normal after stroke surpassed the acute period.

Keywords: circadian rhythm, acute stroke, blood pressure, heart rate, blood glucose.