Korelasi antara Gambaran Spektral Doppler Arteri Tibialis Posterior dan Arteri Dorsalis Pedis dengan Skor PEDIS pada Penderita Ulkus Kaki Diabetik

Abstract

Abstract: Diabetic foot ulcer is still a major health problem worldwide due to its increasing prevalence. This study was aimed to prove the correlation between PEDIS score and vascular Doppler examination performed on dorsalis pedis and posterior tibial arteries of patients with diabetic foot ulcers. This was an observational study with a cross sectional design. The results showed that during the period of August 2017 until January 2018, there were 62 patients with diabetic foot ulcers at the wards of Surgery Department and Internal Medicine Department of Prof. Dr. R. D. Kandou Hospital Manado. Most patients were in the age group of 60-69 years, had leukocytosis (74.1%), poor blood sugar control (70.9%), and hypoalbuminemia (98.3%). Moreover, smoking history in 20.9% of patients; hypertension in 35.4% of patients; and dyslipidemia in 20.9% of patients. The Doppler examination resulted in biphasic waveform in posterior tibial artery (40.3%) as well as in dorsalis pedis artery (41.9%). Perfusion score showed 50% of subjects had PAD. Most subjects (90.3%) had ulcers of >3 cm2 and were infected superficially in the subcutaneous area (56.4%). Most subjects (58%) suffered from severe infection with high leucocyte counts, however, only 29% of subjects had lost of sensoric ability. The correlation Spearman test obtained r = -0.486 and P = 0.000 in the posterior tibial artery; and r = -0.281 and P = 0.0027 in the dorsalis pedis artery. Conclusion: There was a significant correlation between vascular Doppler result and PEDIS score. The higher the PEDIS score, the worse the vascular Doppler result.
Keywords: diabetic foot ulcer, PEDIS score, vascular Doppler

Abstrak: Ulkus kaki diabetik masih merupakan masalah kesehatan utama sedunia dengan prevalensi yang terus meningkat. Penelitian ini bertujuan untuk membuktikan apakah terdapat hubungan antara skor PEDIS dan pemeriksaan spektral Doppler vaskuler pada arteri poplitea, dorsalis pedis, dan tibialis posterior pada pasien dengan ulkus kaki diabetik. Jenis penelitian ialah observasional dengan desain potong lintang. Hasil penelitian mendapatkan 62 pasien dengan ulkus kaki diabetik di bangsal Bagian Bedah dan Penyakit Dalam RSUP Prof. Dr. R. D. Kandou Manado selama periode Agustus 2017 sampai Januari 2018. Ukus diabetik tersering ditemukan pada kelompok usia 60-69 tahun dengan rerata usia 58,5 tahun. Sebagian besar pasien mengalami leukositosis (74,1%), kontrol gula darah buruk (70,9%), dan hipoalbuminemia (98,3%). Riwayat merokok didapatkan sebesar 20,9%; hipertensi 35,4%; dan dislipidemia 20,9%. Hasil pemeriksaan Doppler bifasik pada arteri tibialis posterior (40,3%) dan arteri dorsalis pedis (41,9%). Skor perfusi menunjukkan 50% subyek mengalami penyakit arteri perifer (PAD). Sebagian besar (90,3%) subjek memiliki ulkus >3 cm2 luas area. Infeksi sebagian besar superfisial di subkutan (56,4%), selebihnya menderita infeksi hingga fasia, otot, dan tendon. Sebagian besar subyek penelitian menderita infeksi berat (58%) dengan angka leukosit tinggi. Hanya 29% dari subjek penelitian mengalami kehilangan kemampuan sensorik. Hasil uji korelasi Spearman mendapatkan pada arteri tibialis posterior: r = -0,486 dengan P = 0,000 dan pada arteri dorsalis pedis: r = -0,281 dengan P = 0,0027. Simpulan: Terdapat hubungan bermakna antara hasil pemeriksaan spektral Doppler dan skor PEDIS. Semakin tinggi skor PEDIS semakin buruk hasil spektral Doppler.
Kata kunci: ulkus kaki diabetik, skor PEDIS, Doppler spektral vaskular