KARYA TULIS AKHIReprints.umm.ac.id/47130/55/PENDAHULUAN[1].pdfSirkumsisi berdasarkan Indeks Massa...
Transcript of KARYA TULIS AKHIReprints.umm.ac.id/47130/55/PENDAHULUAN[1].pdfSirkumsisi berdasarkan Indeks Massa...
i
KARYA TULIS AKHIR
PERBEDAAN LAMA PENYEMBUHAN LUKA SIRKUMSISI
BERDASARKAN INDEKS MASSA TUBUH
Oleh:
ZULVIA SABILLAH PUTRI
201510330311058
UNIVERSITAS MUHAMMADIYAH MALANG
FAKULTAS KEDOKTERAN
2019
ii
HASIL PENELITIAN
PERBEDAAN LAMA PENYEMBUHAN LUKA SIRKUMSISI
BERDASARKAN INDEKS MASSA TUBUH
KARYA TULIS AKHIR
Diajukan kepada
Universitas Muhammadiyah Malang
untuk Memenuhi Salah Satu Persyaratan
dalam Menyelesaikan Program Sarjana
Fakultas Kedokteran
Oleh:
ZULVIA SABILLAH PUTRI
201510330311058
UNIVERSITAS MUHAMMADIYAH MALANG
FAKULTAS KEDOKTERAN
2019
i
ii
iii
iv
KATA PENGANTAR
Assalamu’alaikum Warahmatullah Wabarakatuh
Alhamdulillahi rabbil aalamiin, Atas nikmat Allah Subhanahu Wa Ta’ala yang
Maha Pengasih dan Maha Penyayang, penulisan tugas akhir ini dapat selesai
dengan baik. Shalawat serta salam selalu tercurahkan kepada Rasulullah
Muhammad shalallahu alaihi wassalam, keluarganya dan para sahabatnya yang
telah berjasa membawa syiar dakwah Islam ke seluruh dunia.
Penelitian tugas akhir ini berjudul “Perbedaan Lama Penyembuhan Luka
Sirkumsisi berdasarkan Indeks Massa Tubuh”. Tugas akhir ini diajukan untuk
memenuhi persyaratan Pendidikan Sarjana Fakultas Kedokteran Universitas
Muhammadiyah Malang.
Penulis menyadari bahwa tugas akhir ini masih jauh dari kata sempurna, oleh
karena itu, penulis sangat mengharapkan saran dan masukan yang membangun.
Semoga karya tulis ini dapat menambah wawasan keilmuan dan bermanfaat bagi
semua pihak.
Wassalamu’alaikum Warahmatullah Wabarakatuh
Malang, 19 Juni 2019
Penulis
v
UCAPAN TERIMA KASIH
1. Allah SWT yang telah memberikan rahmat, karunia kesehatan, kesabaran dan
lindungan sehingga penulis dapat menyelesaikan tugas akhir ini.
2. Kedua orangtua tercinta, ayahku dr. H. Imam Khudori dan ibuku Umi Nur
Azizah, SP, MMA serta adik-adikku tersayang, Muhammad Fakhrizal,
Fauziah Luthfinnadia, dan Khalisa Althafani, atas cinta dan kasih sayang,
dukungan, serta doa yang tak pernah putus dalam setiap proses yang peneliti
jalani hingga tugas akhir ini dapat terselesaikan dengan lancar.
3. Dr. dr. Meddy Setiawan, Sp.PD, FINASIM, selaku Dekan Fakultas
Kedokteran Universitas Muhammadiyah Malang.
4. dr. Mochamad Ma’roef, Sp.OG., selaku Wakil Dekan I Fakultas Kedokteran
Universitas Muhammadiyah Malang
5. dr. Sri Adilla Nurainiwati, Sp.KK., selaku Wakil Dekan II Fakultas
Kedokteran Universitas Muhammadiyah Malang.
6. dr. Indra Setiawan, Sp.THT-KL., selaku Wakil Dekan III Fakultas
Kedokteran Universitas Muhammadiyah Malang
7. dr. Mochammad Aleq Sander M,Kes, Sp.B., FINACS selaku Pembimbing I,
atas kesabaran, kebaikan hati, serta kesediaan dalam meluangkan waktu
selama membimbing penulis sehingga dapat menyelesaikan penelitian ini
dengan baik.
8. Dr. dr. Fathiyah Safithri, M.Kes selaku Pembimbing II, atas kesabaran,
kebaikan hati, serta kesediaan dalam meluangkan waktu selama membimbing
penulis sehingga dapat menyelesaikan penelitian ini dengan baik.
vi
9. dr. Gita Sekar Prihanti, M.PdKed selaku Penguji, atas segala masukan dan
arahan demi kesempurnaan tugas akhir ini
10. Seluruh staff TU, Bu Endah, Pak Heri, Mbak Citra, Mas Nyono, Pak Joko
dan Bu Fat serta Mbak Deva yang bersedia membantu setiap tahapan proses
penelitian hingga penyelesaian tugas akhir ini.
11. Ragil Mu’allimah, sahabat yang selalu mengirimkan semangatnya dari jauh,
sehingga penulis selalu ingat bahwa karya tulis ini harus segera penulis
selesaikan.
12. Fadhillah Ainnurohmah, Ikmalun Natiq, Novia Rahmawardani, yang selalu
memberikan bantuan, dukungan dan semangat serta doa dalam proses
penyelesaian tugas akhir ini.
13. Saudara-saudara TBMM diklat 13 dan seluruh anggota yang lainnya atas
dukungan, bantuan, dan doa yang senantiasa diberikan dalam penyelesaian
tugas akhir ini.
14. Sejawat FK UMM angkatan 2015, Metacarpalis, atas dukungan, bantuan dan
kerjasama yang terjalin satu sama lain.
15. Stray Kids, yang selalu memotivasi penulis saat jatuh bangun dalam proses
penulisan melalui pesan dalam lagu-lagunya dalam proses penyelesaian tugas
akhir ini.
16. Semua pihak yang terlibat secara langsung maupun tidak langsung dalam
penyelesaian tugas akhir ini, penulis menyampaikan terima kasih.
Penulis
ix
DAFTAR ISI
Halaman
LEMBAR PENGESAHAN ................................................................................ i
PERNYATAAN ORISINALITAS ..................................................................... ii
LEMBAR PENGUJIAN ..................................................................................... iii
KATA PENGANTAR ........................................................................................ iv
UCAPAN TERIMA KASIH ............................................................................... v
ABSTRAK .......................................................................................................... vii
ABSTRACT .......................................................................................................... viii
DAFTAR ISI ....................................................................................................... ix
DAFTAR TABEL ............................................................................................... xii
DAFTAR GAMBAR .......................................................................................... xiii
DAFTAR SINGKATAN .................................................................................... xiv
DAFTAR LAMPIRAN ....................................................................................... xv
BAB 1 PENDAHULUAN ................................................................................ 1
1.1 Latar Belakang ................................................................................ 1
1.2 Rumusan Masalah ........................................................................... 2
1.3 Tujuan Penelitian ............................................................................ 2
1.3.1 Tujuan Umum ........................................................................ 2
1.3.2 Tujuan Khusus ....................................................................... 3
1.4 Manfaat Penelitian .......................................................................... 3
BAB 2 TINJAUAN PUSTAKA ....................................................................... 4
2.1 Sirkumsisi ....................................................................................... 4
2.1.1 Pengertian Sirkumsisi ............................................................ 4
2.1.2 Tujuan Sirkumsisi .................................................................. 5
2.1.3 Indikasi Sirkumsisi ................................................................ 5
2.1.4 Kontraindikasi Sirkumsisi...................................................... 8
2.1.5 Metode Sirkumsisi ................................................................. 9
2.1.6 Komplikasi Sirkumsisi ........................................................... 11
2.1.7 Perawatan Pasca Sirkumsisi .................................................. 13
2.2 Penyembuhan Luka ......................................................................... 16
x
2.2.1 Fisiologi Penyembuhan Luka ................................................ 16
2.2.2 Faktor yang Mempengaruhi Kecepatan Penyembuhan Luka 17
2.2.3 Kriteria Penyembuhan Luka Sirkumsisi ................................ 18
2.3 Pengaruh Obesitas terhadap Penyembuhan Luka ........................... 20
2.4 Indeks Massa Tubuh (IMT) ............................................................ 22
2.4.1 Pengertian IMT ...................................................................... 22
2.4.2 Komponen IMT ..................................................................... 23
2.4.3 Cara Menghitung IMT ........................................................... 24
2.4.4 Faktor yang Mempengaruhi IMT .......................................... 28
2.4.5 Kelebihan dan Kekurangan IMT ........................................... 30
BAB 3 KERANGKA KONSEP DAN HIPOTESIS ......................................... 32
3.1 Kerangka Konsep ............................................................................ 32
3.2 Hipotesis Penelitian ........................................................................ 34
BAB 4 METODE PENELITIAN...................................................................... 35
4.1 Jenis Penelitian................................................................................ 35
4.2 Lokasi dan Waktu Penelitian .......................................................... 35
4.3 Populasi dan Sampel Penelitian ...................................................... 35
4.3.1 Populasi .................................................................................. 35
4.3.2 Sampel ................................................................................... 35
4.3.3 Besar Sampel ......................................................................... 35
4.3.4 Teknik Pengambilan Sampel ................................................. 36
4.3.5 Karakteristik Sampel Penelitian............................................. 36
4.3.6 Variabel Penelitian ................................................................. 37
4.3.7 Definisi Operasional .............................................................. 37
4.4 Alat dan Bahan Penelitian ............................................................... 39
4.5 Prosedur Penelitian ......................................................................... 39
4.6 Alur Penelitian ................................................................................ 40
4.7 Analisis Data ................................................................................... 40
4.8 Jadwal Penelitian ............................................................................ 41
BAB 5 HASIL PENELITIAN .......................................................................... 42
5.1 Hasil Penelitian ............................................................................... 42
5.2 Analisis Data ................................................................................... 44
xi
BAB 6 PEMBAHASAN ................................................................................... 46
BAB 7 KESIMPULAN DAN SARAN............................................................. 50
7.1 Kesimpulan ..................................................................................... 50
7.2 Saran ............................................................................................... 50
DAFTAR PUSTAKA ......................................................................................... 51
LAMPIRAN ........................................................................................................ 55
xii
DAFTAR TABEL
Halaman
2.1 Kategori Indeks Massa Tubuh Menurut WHO ...................................... 24
2.2 Kategori Indeks Massa Tubuh Menurut Depkes RI ............................... 25
2.3 Kategori Indeks Massa Tubuh pada Anak-Anak dan Remaja ............... 28
4.1 Definisi Operasional............................................................................... 37
4.2 Jadwal Penelitian .................................................................................... 41
5.1 Indeks Massa Tubuh Pasien Sirkumsisi ................................................. 42
5.2 Distribusi Sampel berdasarkan Lama Penyembuhan Luka Sirkumsisi.. 43
5.3 Analisis Perbedaan Lama Penyembuhan Luka Sirkumsisi berdasarkan IMT . 45
xiii
DAFTAR GAMBAR
Halaman
2.1 Pengaruh Obesitas terhadap Penyembuhan Luka .....................................22
2.2 Kurva Pertumbuhan CDC 2000 pada Laki-laki ........................................26
2.3 Kurva Pertumbuhan CDC 2000 pada Perempuan .....................................27
3.1 Kerangka Konseptual Penelitian ...............................................................32
4.1 Alur Penelitian ..........................................................................................40
5.1 Distribusi Lama Penyembuhan Luka Sirkumsisi berdasarkan IMT .........43
xiv
DAFTAR SINGKATAN
WHO : World Health Organization
SAW : Shallallahu ‘alaihi wasallam
HR : Hadis Riwayat
SWT : Subhanahu wa Ta’ala
IMT : Indeks Massa Tubuh
Riskesdas : Riset Kesehatan Dasar
Kg : Kilogram
M : Meter
Depkes : Departemen Kesehatan
RI : Republik Indonesia
CDC : Centers for Disease Control
BMI : Body Mass Index
IDAI : Ikatan Dokter Anak Indonesia
HPV : Human Papillomavirus
STD : Sexual Transmitted Disease
ATP : Adenosin Tri Phospat
BB : Berat Badan
HIF1α : Hypoxia-inducible factor 1 alpha
LOX : Lysil oxidase
NO : Nitric oxyde atau Nitrit Oksida
xv
DAFTAR LAMPIRAN
Halaman
1. Informed Consent Penelitian ....................................................................55
2. Kuesioner Pendampingan ........................................................................59
3. Checklist Komunikasi, Informasi, dan Edukasi .......................................60
4. Surat Keterangan Lolos Kaji Ilmiah Proposal Penelitian ........................61
5. Ethycal Clearance ....................................................................................62
6. Dokumentasi Penelitian ...........................................................................63
7. Tabulasi Progres Penyembuhan Luka Pasien Sirkumsisi ........................69
8. Hasil Analisis Data ..................................................................................77
9. Surat Keterangan Lolos Kaji Ilmiah Hasil Penelitian ..............................78
10. Lembar Konsultasi ...................................................................................79
11. Hasil Deteksi Plagiasi ..............................................................................80
51
DAFTAR PUSTAKA
Ahmed A., Mungadi I., 2013, Techniques of Male Circumcision, Journal of
Surgical Technique and Case Report, vol. 5, pp. 1-7, [online], (diunduh 22
Maret 2019), tersedia dari: http://www.jstcr.org/article.asp?issn=2006-880
8;year=2013;volume=5;issue=1;spage=1;epage=7;aulast=Abdulwahab%D
Ahmed
Balaprabha G., 2017, Review on Surgical Site Infections, International Journal of
Allied Medical Sciences and Clinical Research (IJAMSCR), vol. 5, no. 2,
pp. 558-569 [online], (diunduh 31 Januari 2019), tersedia dari: http://
ijamscr.com/sites/default/files/articles/IJAMSCR-17-227_558-569.pdf
Barrett K., Barman S., Boitano S., et al, 2016, Ganong’s Review of Medical
Physology 25th
Edition. New York: McGrawl-Hill Education
Butt, Hisham. 2013. Perineal Reconstruction after Extra-Levator
Abdominoperineal Excision (eLAPE): A Systematic Review. International
Journal of Colorectal Disease, vol. 28, no. 11, pp. 1459-1468 [online],
(diunduh 31 Januari 2019), tersedia dari: https://doi.org/10.1007/s00384-
013-1660-6
Cairns J., 2007, Circumcision: A Minor Procedure. Journal of Paediatrics Child
Health, vol. 12, pp. 311-312 [online], (diunduh 27 Maret 2019), tersedia
dari: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528779/
Chen Y., Chang C., Sun C., 2012, Impact of Obesity Control on Circulating Level
of Endothelial Progenitor Cells and Angiogenesis in Response to Ischemic
Stimulation, Journal of Translational Medicine, vol. 10 , no. 86 , pp. 1–11
[online], (diunduh 22 Maret 2019), tersedia dari: https:// translational-
medicine.biomedcentral.com/articles/10.1186/1479-5876-10-86
Dahlan, Sopiyudin M. 2016. Besar Sampel dalam Penelitian Kedokteran dan
Kesehatan. Jakarta: Epidemiologi Indonesia.
Feldblum PJ, Odoyo E, Bailey RC, et al., 2016, Factor Associated with Delayed
Healing in A Study of the PrePex Device for Adult Male Circumcision in
Kenya, Journal of Acquired Immune Deficiency Syndromes [online],
(diunduh 25 Januari 2019), tersedia dari: https://www.ncbi.nlm.nih.gov/
pubmed/27331586
Freedman DS., Horlick M., Berenson GS., 2013, A Comparison of the Slaughter
Skinfold-Thickness Equations and BMI in Predicting Body Fatness and
Cardiovascular Disease Risk Factor Levels in Children, The American
Journal of Clinical Nutrition, no. 98, pp. 1417-1424 [online], (diunduh 27
Maret 2019), tersedia dari: https://academic.oup.com/ajcn/article/98/6/
1417/4577284
52
Guyton A., Hall J., 2016, Guyton and Hall Textbook of Medical Physiology. Edisi
13. Philadelphia: Elsevier
Hill JO., Wyatt HR., Peters JC., 2012, Obesity: Energy Balance and Obesity.
Journal of American Heart Association, no. 126, pp. 126-132 [online],
(diunduh 27 Maret 2019), tersedia dari: http://www.aspeninstitutemexico.
org/wp-content/uploads/2015/08/Energy-Balance-Hill-Circulation-07-201
2.pdf
Hosseinzadeh S., Kafi M., Teimouri M., 2013, PCR Detection Of Campylobacter
Fetus Subspecies Venerealis in Smegma Samples Collected from Dairy
Cattle in Fars, Iran, Journal of Veterinary Research, vol. 4, no. 4, pp. 227-
231 [online], (diunduh 27 Maret 2019), tersedia dari: https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC4279612/
Ikatan Dokter Anak Indonesia, 2013, Kurva Pertumbuhan CDC-2000 Lengkap,
[online], (diunduh 8 Oktober 2018), tersedia dari: http://www.idai.or.id/
downloads/CDC/Kurva-pertumbuhan-CDC-2000-lengkap.pdf
Ismail A., Abushouk AI., Elmaraezy A., et al, 2017, Cutting Electrocautery
versus Scalpel for Surgical Incision: A Systematic Review and Meta-
Analysis, Journal of Surgical Research, vol. 220, pp. 147–163 [online],
(diunduh 27 April 2019), tersedia dari: https://www.journalofsurgical
research.com/article/S0022-4804(17)30468-7/fulltext
Karita, Dewi., Romdhoni, M Fadhol., 2018, Hubungan Usia dan Berat Badan
Dengan Ukuran Lingkar Penis Anak Menggunakan O-Meter Sirkumsisi
Metode Klem, Jurnal FK, vol. 1, pp. 1-7 [online], (diunduh 5 Oktober
2018), tersedia dari: http://jurnalnasional.ump.ac.id/index.php/HMJ
/article/view/2479
Kindt TJ., Osbome BA., Goldsby RA., 2013, Kuby Immunology. Edisi 7. New
York: W. H. Freeman and Company
Kuczmarski RJ, Ogden CL, Guo SS, et al, 2000, CDC (Center for Disease
Control) Growth Charts for the United States: Methods and Development,
[online], (diunduh 11 Juni 2018), tersedia dari: https://www.cdc.gov
/nchs/data/series/sr11/sr11246.pdf
Kuk, Jennifer., Janiszewski, Peter., Ross, Robert., 2007, Body Mass Index and
Hip and Thigh Circumferences are Negatively Associated with Visceral
Adipose Tissue after Control for Waist Circumference. The American
Journal of Clinical Nutrition, vol. 85, pp. 1540-1544 [online], (diunduh 27
Maret 2019), tersedia dari: https://academic.oup.com/ajcn/article/85/6/
1540/4633151
53
Leslie S, Taylor R, 2018, Zipper Injuries, Florida: Statpearls Publishing LLC,
[online], (diunduh 11 Juni 2018), tersedia dari: https://www.ncbi.
nlm.nih.gov/books/NBK441886/
Michailidou Z., Turban S., Miller E., et al, 2012, Increased Angiogenesis Protects
against Adipose Hypoxia and Fibrosis in Metabolic Disease-resistant 11β-
Hydroxysteroid Dehydrogenase Type 1 (HSD1)-deficient Mice, Journal of
Biological Chemistry, no. 287, pp. 4188-4197 [online], (diunduh 22 Maret
2019), tersedia dari: http://www.jbc.org/content/287/6/ 4188
Morris BJ., Eley C., 2011, Male Circumcision: An Appraisal of Current
Instrumentation, Biomedical Engineering, chapter 164 [online], (diunduh
22 Maret 2019), tersedia dari: https://www.intechopen.com/books/
biomedical-engineering-from-theory-to-applications/male-circumcision-an
-appraisal-of-current-instrumentation
Morris B., Waskett J., Banarjee J., et al, A ‘Snip' in Time: What is the Best Age to
Circumcise?, Journal of Biomedical Central Pediatrics, vol. 12, no. 20, pp.
1-15 [online], (diunduh 27 Maret 2019), tersedia dari: https://bmcpediatr.
biomedcentral.com/articles/10.1186/1471-2431-12-20
Mrdjenovick DE., Fleck CA., 2011, Consider Skin Hygiene and Care Beyond the
Wound, Journal of The American College of Clinical Wound Specialist,
vol. 3, no. 2, pp. 45-47 [online], (diunduh 27 April 2019), tersedia dari:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601933/
Mulia, Yusuf Alfi., Adiputra, Putu Anda Tusta., 2013, Teknik Guillotine dan
Gomco Clamp pada Sirkumsisi. E-Jurnal Medika Udayana, pp. 410-427
[online], (diunduh 5 Oktober 2018), tersedia dari: https://ojs.unud.ac.id
/index.php /eum/article/view/4931
Patricia, D. 2011. Kamus Kedokteran Dorland. Jakarta: EGC
Purnomo, B. 2011. Dasar-Dasar Urologi Edisi 3. Jakarta: Sagung Seto
Riset Kesehatan Dasar, 2007 [online], (diunduh 5 Oktober 2018), tersedia dari:
http://terbitan.litbang.depkes.go.id/penerbitan/index.php/lpb/catalog/downl
oad/22/22/29-2
Said S, Taslim N, Bahar B, 2016, Body Mass Index and Albumin Level related to
Wound Healing, The English Language of JKP, vol. 4 no. 1, pp. 60-66
[online], (diunduh 11 Januari 2019), tersedia dari: http://jkp.fkep.unpad.
ac.id/index.php/jkp /article/download/137/118
Silvignanam G., 2014, An Evolving Curse on Paracetamol Use in Children.
Journal of Pharmacology and Pharmacotherapeutics, vol. 5, pp. 72-73
[online], (diunduh 27 Maret 2019), tersedia dari: http://www.jpharmacol.
54
com/article.asp?issn=0976-500X;year=2014;volume=5;issue=1;spage=72;
epage=73;aulast=Sivagnanam
Sjamsuhidajat R, Prasetyono T, Rudiman R, et al. 2010. Buku Ajar Ilmu Bedah.
Edisi 4. Jakarta: EGC
Spencer M., Unal R., Zhu B., et al, 2011, Adipose Tissue Extracellular Matrix
and Vascular Abnormalities in Obesity and Insulin Resistance, The
Journal of Clinical Endocrinology & Metabolism, vol. 96, pp. E1990-
E1998, [online], (diunduh 22 Maret 2019), tersedia dari: https://academic.
oup.com/jcem/article/96/12/E1990/2834846
Sugondo S., Sudoyo W., Setiyohadi B., et al. 2016. Buku Ajar Ilmu Penyakit
Dalam Edisi 6. Jakarta: Interna Publishing
Syamsir, H. 2014. Sirkumsisi Berbasis Kompetensi. Jakarta: EGC
Townsend C., Beauchamp R., Evers B., et al, 2010, Pocket Companion to
Sabiston Textbook of Surgery, New York: Elsevier Inc
Versprille L, Loo A, Mackus M, et al, 2015, Development of The Immune Status
Questionnaire (ISQ), Universiteit Utrecht, pp. 357 [online], (diunduh 15
Februari 2019), tersedia dari: https://www.ecnp.eu/presentationpdfs/73/
P.357.pdf
Weiss, Helen. 2010. Neonatal and Child Male Circumcision A Global Review.
Publikasi WHO [online], (diunduh 8 Oktober 2018), tersedia dari:
http://www.who.int/hiv/pub/malecircumcision/neonatal_child_MC_UNAI
DS.pdf?ua=1
Weiss H., Polonsky J., Bailey R., et al., 2007, Male Circumcision: Global Trends
and Determinants of Prevalence, Safety, and Acceptability, World Health
Organization and the Joint United Nations Programme on HIV/AIDS
(UNAIDS), [online], (diunduh 22 Maret 2019), tersedia dari: http://data.
unaids.org /pub/Report/2007/jc1360_male_circumcision_en.pdf
Widyastuti, Yuli., Widyaningsih, Risti., 2016, Hubungan Antara Indeks Massa
Tubuh (IMT) dan Kadar Hemoglobin dengan Proses Penyembuhan Luka
Post Operasi Laparotomi, Indonesian Journal on Medical Science, vol. 3,
no. 2, pp. 48-53 [online], (diunduh 9 Oktober 2018), tersedia dari:
https://ejournal.ijmsbm.org/index.php/ijms/article/view/83/83
Yvonne, Trish, Salas, et al., 2014, Obesity and Surgical Wound Healing,
International Scholarly Research Notices, pp.1-13 [online], (diunduh 11
Januari 2019), tersedia dari: https://www.hindawi.com/journals/isrn/
2014/638936/