BAGIAN ILMU KESEHATAN KESEHATAN MASYARAKAT FAKULTAS KEDOKTERAN UNIVERSITAS PATTIMURA
REFERAT FEBRUARI 2017
PERANAN TERAPI OKSIGEN HIPERBARIK PADA PENYAKIT DEKOMPRESI
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DIBA8AKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK PADA BAGIAN ILMU KESEHATAN MASYARAKAT FAKULT FAKULTAS KEDOKTERAN KEDOKTER AN UNIVERSITAS PATTIMURA AMBON 2017 BAB I
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PENDAHULUAN
Bila seseorang masuk ke bawah permukaan air dan menyelam semakin dalam, maka tekanan yang akan diterimanya menjadi semakin besar. Hal tersebut terjadi disebabkan oleh karena berat jenis air lebih tinggi dan pada udara. Tekanan yang diterima tubuh akan diteruskan ke seluruh organ tubuh termasuk kecairan jaringan. Tekanan yang ditermia tidak hanya berpengaruh mekanis, tetapi juga menyebabkan gasgas-ga gass dala dalam m udar udaraa nafa nafass menj menjad adii lebi lebih h bany banyak ak yang yang terl terlar arut ut dan dan dapa dapatt menimbulkan gangguan pada difusi dan transportasi gas pada proses pernafasan. Orang Orang yang dihubu dihubungka ngkan n dengan dengan permuk permukaan aan air melalu melaluii sistem sistem salura saluran n (selan (selang g pernafasan, tidak mampu mengembangkan rongga dadanya (melakukan inspirasi bila kedal kedalam aman an penye penyela lama manny nnyaa !" #. $ada $ada kedal kedalam aman an ters terseb ebut ut,, tekan tekanan an air air yang yang menekan rongga dada tidak dapat diatasi oleh otot-otot inspirasi, oleh karena itu diperlukan tekanan udara inspirasi yang lebih tinggi agar udara dapat masuk ke dalam paru-paru. Tekanan Tekanan tinggi termaksudlah yang menjadi pokok permasalahan pada timbulnya $enyakit %ekompresi. $enyakit $enyakit %ekompresi %ekompresi ($% adalah penyakit dengan berbagai tingkat tingkat keluhan keluhan dan gejala, yang dapat menggangu seluruh sistem organ tubuh dengan penyebab yang sama yaitu terbentuknya gelembung &' dalam jaringan dan darah. elembung terjadi akibat berkurangnya tekanan barometer yang menyertai penyembulan (ascent dalam upay upayaa menga mengakh khir irii peny penyel elam aman an.. $% dapat dapat terj terjad adii pada pada seti setiap ap saat saat dari dari seja sejak k dimulainya penyembulan, tetapi biasanya menjadi jelas setelah ') jam. elembung &' dapat terjadi pada berbagai jaringan, dan dapat dapa t menyebabkan rasa terganggu (rasa tidak enak, bahkan rasa nyeri. %alam pembuluh darah, gelembung udara tersebut menjadi emboli yang dapat menyumbat pembuluh darah penderitanya.
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Tepat patnya nya di nggr nggriis tahu tahun n *' *' oleh oleh Hens Hensha haw w, uan uang g /dar /daraa Berte erteka kana nan n Tinggi0/BT ( Hyperbaric Hyperbaric Chamber Cha mber digunakan untuk mengobati beberapa penyakit kuli kulitt dan dan ricke rickets ts.. %i $era $eranci nciss tahu tahun n *12) *12) oleh oleh dr 3uno 3unott menya menyata takan kan adany adanyaa penyembuhan bermakna pada pasien dengan penyakit kardiopulmoner yang diobati degan degan hiperb hiperbari arik. k. %i ndone ndonesia sia pada pada tahun tahun *45, *45, pengoba pengobatan tan hiperb hiperbari arik k mulai mulai digunakan oleh T&-67 yang selanjutnya dikembangkan di Tanjung $inang, 3akarta, 6mbon, 6mbon, 7akesl 7akeslaa 8urabay 8urabaya, a, yang yang digunak digunakan an untuk untuk menanga menangani ni kasuskasus-kas kasus us cedera cedera penyelamanan seperti keracunan gas pernapasan dan penyakit dekompresi.
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A" PENY PENYAKIT DEKOMP DEKOMPRES RESII 1" De:inisi Caisson Caisson disease disease (sinonim: (sinonim: Bends, Compress Compressed ed Air Sickness, Sickness, Divers’ Divers’ss
Paralysis, Dysbarism) Dysbarism) adalah bila seorang penyelam telah lama berada di dalam laut sehingga sejumlah besar nitrogen terlarut dalam tubuhnya, dan kemudian tiba-tiba naik ke permukaan laut, sejumlah gelembung nitrogen dapat timbul dalam cairan tubuhnya baik dalam sel maupun diluar sel, dan hal ini dapat menimbulkan menimbulkan kerusakan kerusakan di setiap tempat dalam tubuh, dari derajad ringan sampai berat bergantung pada sejumlah dan ukuran gelembung yang terbentuk.* 9aisson 9aisson disease (9% atau decompression sickness adalah suatu penyakit atau kelainan-ke kelainan-kelaina lainan n yang diakibatkan diakibatkan oleh oleh cepa cepatt
dise diseki kita tarn rnya ya
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gelembung-gelembung gas dari fase larut dalam darah atau jaringan. :kspansi gas dari paru-paru dapat mengakibatkan ruptur al;eolus yang biasa disebut dengan < Pulmonary verin!la"ion Syndrome=. Syndrome=. $enurunan tekanan yang tibatiba tadi dapat mengakibatkan adanya emboli udara di arteri.' 2" Kl$si $si:i5$ :i5$ssi a. Tipe Tipe penyaki penyakitt dekompr dekompresi esi biasan biasanya ya menyebab menyebabkan kan nyeri nyeri semaki semakin n memburuk pada sendi (biasanya siku dan bahu, punggung, dan otototot, rasa sakit termasuk termasuk manifestas manifestasii lain limfadenopat limfadenopati, i, bintik-bin bintik-bintik tik b.
kulit, gatal , dan ruam.2 Tipe penyakit dekompresi cenderung menyebabkan gejala neurologis dan kadang-kadang kadang-kadang pernapasan. pernapasan. ni biasanya biasanya memanifesta memanifestasikan sikan dengan paresis, mati rasa dan kesemutan, kesulitan buang air kecil, dan kehilangan kontrol kandung kemih atau usus. 8akit kepala dan kelelahan ki
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kebingungan, kebingungan, dan koma. >ematian dapat terjadi. Tersedak Tersedak (penyakit (penyakit dekompr dekompresi esi pernap pernapasa asan n merupak merupakan an manife manifesta stasi si yang yang jarang jarang namun namun serius, serius, termasuk gejala sesak napas, nyeri dada, dan batuk. elembung elembung embolisasi besar dari pohon pembuluh darah paru bisa mengakibatkan peredaran darah yang cepat dan kematian.2 +" E4i.l.3i $enyakit dekompresi biasanya diakibatkan oleh pembentukan gelembung gas, yang dapat menyebar ke seluruh tubuh, yang menyebabkan berbagai macam macam ganggua gangguan.8u n.8uatu atu gelemb gelembung ung gas yang yang terbent terbentuk uk di punggun punggung g atau atau persendian dapat menyebabkan nyeri terlokalisir (the bends.elembung gas pada jaringan medulla spinalis atau pada ner;us perifer dapat menyebabkan paraestesia, neuropra?ia, atau paralisis. 8ementara gelembung gas yang terbent terbentuk uk pada system system sirkul sirkulasi asi dapat dapat mengaki mengakibat batkan kan emboli emboli gas pada pada pulmonal atau serebrum. Beberapa macam gas bersifat lebih mudah larut dalam dalam lemak. lemak.&it &itrog rogen en misalny misalnya, a, " kali kali lebih lebih larut larut dalam dalam lemak lemak daripa daripada da dalam air .',) " Fisi Fisi5$ 5$ /en /enel el$# $#$n $n Tekan Tekanan an udara udara pada permukaan permukaan laut laut pada pada suhu suhu 5o 9, pada pada dasarny dasarnyaa adalah tekanan yang disebabkan oleh berat asmofir diatasnya. Tekanan ini konst konstan an yait yaitu u seki sekita tarr +5 mmHg mmHg (*),+ (*),+ psi psi dan dan dija dijadi dika kan n dasa dasarr hukum hukum atmosfir (* 6T6.
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dan tidak berkurang. $ada setiap tempat di bawah permukaan air tekanan akan meningkat sebesar +5 mmHg (* 6tmosfir untuk setiap kedalaman *5 meter. %enga %engan n demik demikia ian n penam penambah bahan an teka tekanan nan air air perm permuk ukaan aan deng dengan an tekan tekanan an kedalaman air disebut tekanan 6tmosfir 6bsolut (6T6. /dar /daraa yang yang dihi dihiru rup p manu manusi siaa adala adalah h udar udaraa bias biasaa yang yang terd terdir irii dari dari komponen-komponen sebagai berikut@ ) +1 A &itrogen (&' ) '* A Oksigen (O' ) 5,42 A 6rgon (6r ) 5,5) A >arbondioksida (9O' ) 8isanya gas-gas mulia (He, &e,dll
%alam penyelaman penyelaman maka hukum-hukum hukum-hukum gas berlaku berlaku karena tekanan dan ;olume gas yang keluar masuk tubuh manusia berubah sesuai keadaan.%alam menyelam harus mengetahui terlebih dahulu dasar-dasar penyelaman yang
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penyelaman.isika penyelaman adalah ilmu yang mempelajari tentang penyelaman dengan menggunakan hukum-hukum fisika. Hukum-hukum tersebut dapat di jelaskan sebagai berikut@ a. Hukum Boy Boylle Hukum Boyle menegaskan hubungan antara tekanan dan ;olume. Colume dari suatu kumpulan gas akan berbanding terbalik dengan absolut yaitu@ V =
P V
1
P
K
=
6tau $*.C' D $*.C' >eterangan@ $ D Tekanan Tekanan 6bsolut C D Colume Colume > D >onstanta ni ni bera berart rtii bahwa bahwa,, jika jika teka tekanan nan meni meningk ngkat at maka maka ;olu ;olume me dari dari suat suatu u kump kumpul ulan an gas gas akan akan berk berkur uran ang g begit begitu u juga juga seba sebali likny knya. a. 8elam 8elamaa teka tekana nan n seba seband ndin ing g deng dengan an keda kedala lama man n maka maka ;olu ;olume me juga juga terg tergan antu tung ng deng dengan an kedalaman. Bila tekanan ' kali menjadi besar maka ;olume akan menjadi
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8eoran 8eorang g penyela penyelam m yang yang menghi menghirup rup nafas nafas penuh penuh di permuk permukaan aan akan akan meras erasak akan an paru paru-p -par arun uny ya sema semaki kin n lama lama sema semaki kin n tert tertek ekan an oleh oleh air air di sekeli sekelilin lingny gnyaa saat saat dia turun. turun. 8emua 8emua rongga rongga yang yang ada dalam dalam tubuh tubuh akan terpeng terpengaru aruh h hubunga hubungan n ;olume ;olume dan tekana tekanan n ini. ini. #engen #engenai ai teling telingaa bagian bagian tengah, tekanan air yang ada di dalam tubuh akan dihantarkan oleh cairancair cairan an tubuh tubuh kero kerongg nggaa udara udara didal didalam am teli telinga nga tenga tengah. h. 8elam 8elamaa tekan tekanan an meni mening ngkat kat maka maka ;olum ;olumee akan akan berkur berkuran ang g kare karena na teli teling ngaa bagia bagian n teng tengah ah didalam rongga tulang kaku, rongga yang sebelumnya terisi udara akan diisi
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campuran tersebut.3ika gas itu secara sendiri menempati seluruh ruang ;olume. 8elama tekanan secara menyeluruh meningkat, tekanan partial dari dari tiaptiap-ti tiap ap gas gas pun akan akan meni meningk ngkat at.. $ada $ada kedal kedalam aman an )5 mete meter r ( tekanan " 6T6 penyelam yang bernafas dengan udara biasa akan menghirup oksigen dengan tekanan partial yang sama ( * 6T6 seperti bila ia sedang menghirup *55A O' di permukaan air. $emahaman hukum ini penting untuk mengetahui efek toksin gas pernafasan pada kedalaman, penyakit dekompresi dan penggunaan oksigen maupun campuran gas untuk tujuan pengobatan.
c. Hukum He Henry %inyat %inyatakan akan bahwa pada pada suhu suhu tertent tertentu u jumlah jumlah gas yang terlar terlarut ut di dalam dalam suatu suatu cairan cairan berband berbanding ing lurus lurus dengan dengan tekanan tekanan partia partiall dari dari gas tersebut diatas cairan. Bila seorang penyelam turun sampai kedalaman *5 mete meter, r, tekan tekanan an part partia iall nitr nitroge ogen n yang yang dihi dihiru rup p menj menjad adii ' kali kali lipat lipat dibandingkan dengan dipermukaan dan akhirnya nitrogen yang terlarut dalam jaringan juga akan dua kali lipat. Gaktu Ga ktu terjadi keseimbangan keseimbangan tergantung tergantung pada daya larut gas di dalam jaringan dan kecepatan suplai gas ke jaringan oleh darah.$engaruh fisiologi dari hukum terhadap seorang penyelam berlaku untuk penyakit dekom dekom
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sejuml sejumlah ah gas terten tertentu tu adalah adalah berban berbandin ding g lurus lurus dengan dengan suhu suhu absolu absolut. t. Huku Hukum m inji inji sang sangat at erat erat hubu hubung ngan anny nyaa deng dengan an sifa sifatt komp kompre resi si dan dan dekompresi dari gas-gas yang juga berkaitan dengan gas-gas dalam aliran darah berwujud cair di tubuh manusia yang dapat menjadi lewat jenuh saat menyelam dengan tekanan ( tabung . e. Huku Hukum m 6rchi rchime mede dess Huku Hukum m 6rchi rchime mede dess meny menyat atak akan an bahw bahwa@ a@ <8et <8etia iap p
bend bendaa
yang yang
dibenam dibenamkan kan sebagi sebagian an atau atau seluru seluruhny hnyaa kedala kedalam m cairan cairan,, maka maka ia akan mendapat gaya tekanan ke atas sebesar berat cairan yang dipindahkan= 3adi semakin padat cairan itu, maka semakin besar daya apungnya.%engan demikian, penyelam dan kapal mengapung lebih tinggi di laut dari pada di air tawar. %engan %engan paru-p paru-paru aru mengem mengembang bang sepenuh sepenuhnya, nya, biasan biasanya ya orang orang akan akan mengambang mengambang diatas permukaan air laut yaitu dia mempunyai mempunyai daya apung positif. %aya apung positif yaitu bila seseorang cenderung untuk mengambang, mengambang, sedangkan gaya apung negati;e yaitu apabila apabila seseorang seseorang yang cenderung tenggelam dan daya apung netral seseorang cenderung melayang. %ari hukum-hukum tersebut dapat disimpulkan bahwa, fisika penyelaman sangat sangat penting penting sebaga sebagaii dasar dasar penyelam penyelaman an karena karena jika jika tidak tidak mengeta mengetahui hui huk
huku
das
fisik fisik
ela
dapat dapat berdamp berdampak ak buruk buruk
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berhubungan dengan timbulnya peristiwa supersaturasi gas dalam darah ataupun jaringan tubuh pada waktu proses penurunan tekanan di sekitar tubuh (dekompresi. >ondisi supersaturasi gas dalam darah dan jaringan sampai suatu batas tertentu masih dapat ditoleransi, dalam arti masih memberi kesempatan gas untuk untuk berdif berdifusi usi keluar keluar dari dari jaring jaringan an dan larut larut dalam dalam darah, darah, kemudi kemudian an ke al;eoli paru dan diekhshalasi keluar tubuh. 8etelah melewati suatu batas kritis tertentu ( supersa"ura"ion supersa"ura"ion cri"i#ue, cri"i#ue, kondisi supersaturasi akan menyebabkan gas lepas lebih cepat dari jaringan atau darah dalam bentuk tidak larut, yaitu berupa gelombang gas. elembung-gelembung gas ada yang terbentuk dalam darah (intra;askuler, jaringan (ekstra;askuler, dan dalam sel (intraseluler. %engan adanya fenomena seperti di atas, maka ada korelasi antara jumlah gelembung gas yang terbentuk dengan kemungkinan timbulnya atau berat ringannya penyakit dekompresi. elembung gas ekstra;askuler menimbulkan distorsi jaringan dan kemungkinan kerusakan sel-sel di sekitarnya.ni bisa mengak gakibat batkan
gejala-gejal ejalaa
neurologi ogis
maupun pun
gejala
nye nyeri
periartikuler.Te periartikuler.Terbentuknya rbentuknya gelembung gas ekstra;askuler secara teoritis karena aliran darah ;ena di jaringan tersebut yang relati;e lambat sehingga menghambat kecepatan eliminasi gas dari jaringan. elembung-ge elembung-gelembun lembung g gas intra;askul intra;askuler er akan menimbulkan menimbulkan ' akibat, akibat, yaitu@
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menimbulkan gejala nyeri periartikuler maupun gejala-gejala neurologis perifer. elembung gas intra;askuler yang yang ikut sirkulasi bila tidak banyak jumlahnya akan difiltrasi lewat paru ( silen" silen" bubbles. bubbles. Bila Bila jumlahnya banyak akan menimbulkan sumbatan pada sirkulasi pulmoner dan akhirnya masuk ke dalam d alam system arterial lewat shunt di paru. elemb elembung ung gas yang masuk masuk ke siste sistem m arteri arterial al akan akan menimb menimbulk ulkan an gang ganggu guan an
perf perfus usii
mikr mikro; o;as asku kule lerr
orga organn-or orga gan, n,
yang yang
sela selanj njut utny nyaa
mengakibatkan mengakibatkan terjadinya terjadinya iskemia iskemia local, kerusakan jaringan dan infark. infark. >elainan ini bisa memberi gejala neurologis, kardio;askuler dan nyeri. elembu elembung ng gas intra; intra;ask askule ulerr menimb menimbulka ulkan n agregas agregasii trombo trombosit sit pada permukaan antara gelembung gas dan plasma, yang diikuti serangkaian proses reaksi biokimia yang kompleks berupa pelepasan Fat-Fat seperti kateko katekolam lamin, in, 8#6 8#6 (Smoo"h Smoo"h $uscle $uscle Ac"iva Ac"iva"in "in% % &ac"or &ac"or , 69TH 9TH dan dan faktor-faktor humoral lain.
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mempuny mempunyai ai suplai suplai darah darah yang kurang, kurang, sehing sehingga ga memerl memerluka ukan n waktu waktu lebih lebih lama (sampai beberapa jam untuk mencapai mencapai kejenuhan kejenuhan nitrogen.&it nitrogen.&itrogen rogen mempunyai daya larut yang baik dalam jaringan lemak, sehingga jaringan lemak lemak bisa bisa melarut melarutkan kan nitrog nitrogen en lebih lebih banyak banyak daripa daripada da jaring jaringan-j an-jari aringan ngan lainnya. >onsep jaringan cepat dan lambat penting untuk memahami bentuk bentuk klinis penyakit dekompresi yang mungkin timbul. $enyelaman $en yelaman singkat dan dalam dalam akan akan meng menghas hasil ilkan kan pemb pembeb eban anan an nitro nitroge gen n yang yang ting tinggi gi pada pada jaringan-jaringan cepat, tetapi tidak cukup waktu untuk pembebanan tinggi pada jaringan-jaringan lambat. %ekompresi yang inadekuat memungkinkan pembentukan gelembung nitrogen didalam darah yang bisa mengakibatkan gangguan pernapasan (chokes (chokes atau gejala neurologis. $eny $enyel elam aman an yang yang rela relati tiff dang dangka kall tapi tapi lama lama akan akan mem memberi berika kan n pembebanan nitrogen yang kurang lebih sama antara jaringan cepat dan
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didalam tubuh seseorang penyelam pada permukaan, maka pada kedalaman '5 meter (2 6T6 ia akan menyerap 2 liter &'. &' yang berlebihan ini akan didi didist stri ribu busi sika kan n oleh oleh dara darah h ke dala dalam m jari jaring ngan an-j -jar arin inga gan n sesu sesuai ai denga dengan n kecepa kecepata tan n alir aliran an dara darah h ke jari jaringa ngan n ters terseb ebut ut sert sertaa daya daya gabun gabung g jarin jaringa gan n terhadap &'. 3aringan lemak mempunyai daya gabung &' yang tinggi dan melarutkan banyak &' daripada daripada jaringan jaringan yang lainnya. lainnya. >etika >etika penyelam naik ke permuk permukaan aan dan tekanan tekanan gas turun, turun, terjad terjadii kebalik kebalikan an dari dari proses proses yang memenuhi memenuhi tubuh dengan &'. Tekanan parsial &'yang rendah dalam paru-paru selama naik menyebabkan darah melepaskan &' ke dalam paru-paru. $roses ini berlangsung berlangsung beberapa beberapa jam karena jaringan jaringan lambat melepaskan melepaskan &' dengan perlahan-lahan,
dan
tubuh
memerlukan
')
jam
atau
lebih
untuk
menghi menghilan langkan gkan semua semua &' yang yang berleb berlebiha ihan. n. 3ika 3ika dekomp dekompres resii berlan berlangsu gsung ng terlalu cepat, maka &' tidak dapat meninggalkan jaringan dengan cepat dan teratur seperti yang dilukiskan diatas.Tekanan yang tiba-tiba menurun tidak
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Ti/e I 9% tipe ditandai dengan satu atau beberapa dari gejala berikut @) a. asa nyeri nyeri ringan ringan yang yang menetap menetap setelah setelah *5 menit menit onset onset (niggles (niggles,, b. $ruritus, atau
pada kulit, dan c. uam uam pada pada kuli kulitt yang yang bias biasan anya ya bera berane neka ka warn warnaa atau atau meny menyer erup upai ai marmer marmer atau atau papular papular,, atau atau ruam yang menyeru menyerupai pai plak. plak. $ada $ada kasus kasus tertentu yang jarang menyerupai kulit jeruk. Ti/e II
9aisson disease tipe ditandai oleh @) * ' 2
eja ejala la gang ganggu guan an pada pada paru paru,, 8yok 8yok hi hipo;o po;ollemi emik, ata atau u angguan angguan pada sistem sistem saraf. saraf. %ari kasus yang dilapor dilaporkan kan hanya hanya ada sekita sekitar r 25A yang disertai dengan keluhan nyeri. Tanda dan gejalanya ber;ariasi kare karena na kompl kompleks eksnya nya susu susuna nan n sara saraff pusa pusatt dan perif perifer er.. Onset Onset geja gejala la biasanya segera atau hingga 2 jam.
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$" Tin%$ in%$5$ 5$n n %ini %ini /ntuk penatalaksanaan pada pasien 9aisson %isease, pertama-tama
yang harus harus dilaku dilakukan kan adalah adalah memper mempertah tahank ankan an jalan jalan napas napas dengan dengan menjamin menjamin ;entilasi ;entilasi dan mencapai mencapai sirkulasi sirkulasi.$asi .$asien en harus ditempatkan dalam dalam posisi posisi terlen terlentan tang. g. 7angka 7angkah-l h-lang angkah kah penatal penatalaks aksana anaan an lainny lainnyaa meliputi @ 1, $emberian $emberian oksigen *55A *" liter 0 menit dengan menggunakan menggunakan masker reser;oir. &amun perlu diperhatikan pemberian oksigen *55A hanya
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pengobatan %98. 8atu pengecualian untuk aturan ini adalah kasus kelemahan ekstremitas bawah.Heparin molekul berat rendah (7#GH harus digunakan untuk semua pasien dengan ketidakmamp ketidakmampuan uan berjalan berjalan pada setiap tingkat kelumpuhan ekstremitas bawah yang disebabkan oleh %98 neurologis. :no?aparin 25 mg atau setara diberikan secara subkutan setiap *' jam, dimana harus dimulai sesegera mungkin setelah cedera cedera untuk untuk mengur mengurang angii risiko risiko trombo trombosis sis ;ena ;ena dalam dalam (%CT (%CT dan emboli paru pada pasien lumpuh.
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menit.3ika dalam perjalanan kepermukaan timbul gejala maka berhenti selama 25 menit. 8etelah tiba dipermukaan penderita harus menghirup 5' l55A dan udara selama 45 menit, jika gagal maka penderita harus diangkut ke fasilitas /BT. $engangkutan penderita ke fasilitas /BT dapat dilakukan dengan kapal laut, kendaraan darat, pesawat terbang dengan kabin bertekanan * atm, bila tidak ada maka ketinggian maksimum *555 feet (255 meter. 8elama perjalanan penderita mengisap oksigen *55A 25 menit, udara "
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B" TERAPI TERAPI HIPER HIPERBAR BARIK IK OKSIGE OKSIGEN N 'HBOT, 'HBOT, 1+61 1" De:inisi Hiperb Hiperbari arik k berasal berasal dari dari kata kata hyper hyper berart berartii tinggi tinggi,, bar berart berartii tekana tekanan. n.
%engan kata lain terapi hiperbarik adalah terapi dengan menggunakan tekanan yang yang ting tinggi gi.. $ada $ada awal awalny nya, a, tera terapi pi hipe hiperb rbar arik ik hany hanyaa digun digunak akan an untu untuk k mengobati decompression sickness, sickness, yaitu suatu penyakit yang disebabkan oleh penurunan tekanan lingkungan secara mendadak sehingga menimbulkan sejumlah sejumlah gelembung nitrogen dalam cairan tubuh baik didalam sel maupun
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yang secara secara kimiaw kimiawii dilepas dilepaskan kan dari dari paru paru ke jaring jaringan. an. Bernap Bernapas as dengan dengan oksi oksige gen n *55A *55A pada pada atmo atmosf sfer er yang yang norm normal al tida tidak k efek efek pada pada satu satura rasi si hemoglobin. >edua, di bawah tekanan atmosfer, lebih banyak oksigen gas terlarut dalam plasma. #eskipun dalam kondisi normal transport transport oksigen terlarut terlarut dalam dalam plasma plasma jauh jauh lebih lebih signif signifika ikan n daripa daripada da trans transpor portt oleh oleh hemogl hemoglobi obin, n, dengan TOB kontribusi transportasi plasma untuk jaringan oksigenasi sangat meningkat. 8ebenarnya, menghirup oksigen murni pada tiga kali yang normal
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•
9rush njury >eracunan gas karbon monoksida (9O
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$ersiapan terapi oksigen hiperbarik antara lain@ $asien diminta untuk menghentikan kebiasaan merokoknya ' minggu
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Terapi oksigen hiperbarik memerlukan kerjasama multidisiplin sehingga
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Oksi Oksige gena nasi si memil memilik ikii
keunt keuntun ungan gan untu untuk k
mela melawa wan n
hipo hipoks ksia ia jari jaringa ngan, n,
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6. Tabel pengobatan dengan udara tekanan tinggi saat ini sudah ditinggalkan
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Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.