analgesik opiodi dan non opioid

7/23/2019 analgesik opiodi dan non opioid

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getik adalah obat yang digunakan untuk meredakan rasa nyeri. Obat }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl418 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 analgetik dibagi ke dalam dua kelompok, yaitu obat golongan opioid dan NSAID. Golongan Opioid bekerja pada sistemsaraf pusat, sedangkan golongan NSAID bekerja di reseptor saraf perier dan sistem saraf pusat.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 11}{\fs2



1 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-712 \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \tql \tx720 \itap0 \ls2 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Tramadol }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-271 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li720 \ri0\nowidctlpar \nooverflow \adjustright \lin720 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Tramadol merupakan analgetik yang bekerja di sentral yang memiliki afinitas }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0\sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0\par }\pard \plain \qj \li0 \ri0 \sl384 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 sedang pada reseptor mu(\uc1 \u181 ?) dan afinitasnya lemah pada reseptor kappa dan delta opioid.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 13}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Obat golongan opioid sendiri telah banyak digunakan sebagai obat anti nyeri kronis dan nyeri non-maligna.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 14}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-37 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl419 \slmult1 \nowid

ctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Tramadol tergolong dalam opioid sintetik lemah, sehingga dapat berikatan dengan reseptor morfin pada tubuh manusia. Obat ini memiliki efektifitas yang sama dengan morfin atau miperidin walaupun reseptor tramadol berjumlah lebih sedikit.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 15}{\fs21 \kerning2 \dbch \af3 \hich\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-51 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0\sl463 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Tramadol mengikat reseptor \uc1 \u181 ?-opiod, sehingga menyebabkan potensi kerja tramadol menjadi lebih rendah bila dibandingkan dengan morfin. Rese

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li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21\kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par}\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain\qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0\sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0\par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \p

lain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0\ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-233 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li2160 \ri0 \nowidctlpar \adjustright \lin2160 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0\loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Gambar 1}{\fs24\kerning2 \dbch \af0 \hich \af0 \loch \f0 . Rumus Bangun Tramadol}{\fs32 \kernin

g2 \dbch \af0 \hich \af0 \loch \f0 \super1 18}{\fs21 \kerning2 \dbch \af3 \hich\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-208 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl415 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \ker

ning2 \dbch \af0 \hich \af0 \loch \f0 Tramadol dapat diberikan secara oral, i.m. atau i.v. dengan dosis 50-100 mg dan dapat diulang setiap 6-7 jam dengan dosismaksimal 400 mg per hari.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 19,20}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Kadar terapeutik dalam darah berkisar antara 100-300 ng/ml. Obat ini dapat melakukan penetrasi pada sawar darah dengan baik, sehingga konsentrasi tramadol dapat dihitung pada cairanserebrospinal.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 21}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0\loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpa



ge \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn734 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qj \li8180 \ri0 \nowidctlpar \adjustright \lin8180 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page3}{\*\bkmkend page3}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs19 \kerning2 \dbch \af9 \hich \af9 \loch \f9 9}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-351 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl445 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \

hich \af0 \loch \f0 Tramadol 3mg/kg yang diberikan secara oral, i.m. atau i.v. efektif pada pengobatan nyeri sedang hingga berat. Penurunan yang nyata keadaan menggigil setelah operasi yang telah tercatat pada pasien yang ditangani dengan obat ini dan efek depresi pernafasan yang minimal merupakan keuntungan dari obatini. Tramadol memperlambat pengosongan lambung, meskipun efeknya kecil dibandingkan dengan opioid lain.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Selain itu, tramadol jugadapat menyebabkan sensasi berputar, konstipasi, pusing, dan penurunan kesadaran. Penggunaan tramadol sebaiknya dihentikan bila didapatkan gejala seperti kejang, nadi lemah, dan kesulitan bernafas.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 22}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-23 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hi

ch \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl474 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Dibandingan dengan analgesik NSAID, Tramadol lebih aman untuk digunakan karena tidak memiliki efek yang serius terhadap pencernaan, sistem koagulasi, dan ginjal. Obat inibermanfaat pada penanganan nyeri kronik karena obat ini tidak menyebabkan toleransi atau adiksi dan tidak berkaitan dengan toksisitas organ utama atau efek sedatif yang signifikan. Obat ini juga bermanfaat pada pasien yang mengalami intoleransi pada obat anti inflamasi non steroid. Kerugian tramadol antara lain interaksinya dengan antikoagulan koumadin dan kejadian kejang. Oleh karena itu pada pasien epilepsi, penggunaan tramadol sebaiknya dihindari. Selanjutnya efek sampingtramadol yang paling sering terjadi adalah meningkatnya insidensi mual dan muntah pada pasien perioperatif. Odansetron dapat mengganggu}{\fs21 \kerning2 \dbch \

af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn734 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page4}{\*\bkmkend page4}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 10}{\fs21 \kerning2 \dbch \af3 \hich



\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-294 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 komponen analgesik pada tramadol karena efek pada reuptake dan pelepasan }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 5-}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-262 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 hydroxytr

yptamine}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 .}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 17}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-202 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21\kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-712 \li720\ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \tql \tx720 \itap0 \ls3 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Ketorolak }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-271 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \itap0 \fs21 \kerning2 \dbch\af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Keto

rolak merupakan salah satu obat analgetik dari golongan NSAID yang }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-335 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl437 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 merupakan suatu grup yang terdiri dari berbagai struktur kima yang memiliki potensi sebagai antiinflamasi, antipiretik dan analgetik. Obat dengan golongan jenis ini bekerja melalui jalur siklooksigenase yang berdampak pada terjadinya pencegahan sensitisasi nosiseptor perifer karena terjadinya hambatan biosintesis prostaglandin.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-30 \slmult0 \nowidctlpar \adjustright \lin0 \r

in0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl453 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0Ketorolak dapat diberikan secara oral, intramuskular atau intravena. Pemberian secara intratekal dan epidural tidak dianjurkan. Obat ini memiliki potensi yang besar dalam menanggulangi nyeri berat akut, namun memiliki aktifitas anti inflamasi yang sedang bila diberikan secara intra muscular dan intra vena. Ketorolak dapat diberikan sebagai analgesik pasca operatif atau sebagai kombinasi bersama opioid.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs21 \kernin



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\loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-316 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch\af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21\kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs23 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Gambar 2}{\fs23 \kerning2 \dbch \af0 \hich \af0 \loch \f0 . Rumus Bangun Ketorolak.}{\fs31 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 23}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich\af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \marg

bsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain\qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0\itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page5}{\*\bkmkend page5}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 11}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200\slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0



\itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-304 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl448 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Cara kerja ketorolak adalah dengan cara menghambat sintesis prostaglandin secara reversibel di perifer tanpa mengganggu reseptor opioid pada sistem pusat. Ketorolak akan menghambat nyeri dan reaksi inflamasi, sehingga akan mempercepat proses penyembuhan

luka. Obat ini juga memiliki potensi untuk menghambat produksi tromboksan platelet dan agregasi platelet. Ketorolak secara kompetitif menghambat kedua isoenzim COX, COX-1 dan COX-2 dengan potensi yang berbeda, untuk menghasilkan efek farmakologis antiinflamasi, analgesi, dan antipiretik.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 24,25}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Sama seperti NSAID lain, obat ini tidak dianjurkan diberikan untuk wanita hamil, menghilangkan nyeri persalinan wanita sedang menyusui, usia lanjut, anak usia kurang dari 4 tahun, gangguan perdarahan dan bedah tosilektomi.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 13}{\fs21 \kerning2 \dbch \af3 \hich\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-26 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl437 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0

\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Keuntungan dari penggunaan analgesik ketorolak adalah obat ini tidak menyebabkan depresi ventilasi atau kardiovascular. Selain itu, ketorolakhanya memiliki sedikit atau tidak ada efek pada dinamika saluran empedu, menjadikan obat ini lebih berguna sebagai analgesik pada pasien spasme gangguan empedu.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-31 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl412 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Sifat analgetik ketorolak setara dengan opioid, yaitu 30 mg ketorolak yang sama dengan 12 mg morfin atau 100 mg petidin.}{\fs32

\kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 13}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Sifat antipiretik pada ketorolak tergolong rendah. Penggunaan secara oral tidak terlalu bermanfaat pada nyeri akut pasca operasi terutama dengan dosis maksimal sebesar 30 mg/hari.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 26}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Waktuparuh pada orang yang masih muda sekitar 3,5 \uc1 \u8211 ? 9,2 jam, dengan ekskresi lewat ginjal}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \



margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page6}{\*\bkmkend page6}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0\par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch\f9 12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21\kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par}\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain\qj \li0 \ri0 \sl-352 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl429 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 sekitar 91,4% sedangka

n lewat empedu 6,1%. Pemberian dosis ketorolak yang dianjurkan adalah 3-4 kali/hari dengan dosis maksimal im/iv tidak lebih dari 120}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-46 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch\af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 mg/hari.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 13}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-202 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain\qj \fi-772 \li780 \ri0 \nowidctlpar \nooverflow \adjustright \lin780 \rin0 \tql \tx780 \itap0 \ls4 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24

\kerning2 \dbch \af0 \hich \af0 \loch \f0 Nyeri }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-330 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl457 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch\af0 \hich \af0 \loch \f0 Menurut }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 International Association for the Study of Pain}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 (IASP), nyeri merupakan pengalaman sensorik dan emosional yang tidak menyenangkan akibat kerusakan jaringan, baik aktual maupun potensial yang digambarkan dalam bentuk urusan tersebut. Definisi nyeri tersebut menjelaskan konsep bahwa nyeri adalah produk kerusakan struktural, bukan saja responsensorik daei suatu proses nosisepsi, harus dipercaya seperti yang dinyatakan pe

ndertita, tetapi juga merupakan respon emosional yang disadari atas pengalaman termasuk pengalaman nyeri sebelumnya.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-11 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl472 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Persepsi nyeri menjadi sangat subjektif tergantung kondisi emosi dan pengalaman emosional sebelumnya. Toleransi terhadap nyeri meningkat bersama pengertian, simpati, persa



udaraan, alih pengertian, pemberiian analgesi, ansiolitik, antidepresan, dan pengurangan gejala. Sedangkan toleransi menurun pada keadaan marah, cemas, kebosanan, kelelahan, depresi, penolakan sosial, isolasi mental, dan keadaan yang tidakmenyenangkan. Plastisitas saraf sentral maupun perifer menjadi dasar pengetahuan nyeri patologik atau yang diidentikan sebagai nyeri kronik. Nyeri pasca operasi memicu respon stress yaitu respon neuro endokrin yang berpengaruh}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21\kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page7}{\*\bkmkend page7}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0\'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 13}{\fs21 \kerning2 \dbch\af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21\kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \s

l-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0\rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-352 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl373 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 pada mortalitas dan berbagai morbiditas pascaoperasi. Nyeri operasi bersifat }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 self}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 limiting }{\fs24 \kerning2 \dbch \af0 \hich \af0 \lo

ch \f0 (tidak lebih dari 7 hari).}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-103 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3\hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl447 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24\kerning2 \dbch \af0 \hich \af0 \loch \f0 Nyeri hebat memicu kejadian nyeri kronik di kemudian hari, penyebab penting respon stress dan alasan humanitas maka nyeri operasi harus ditanggulangi berbeda dengan nyeri kronik berdasarkan }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 three step analgetic ladder}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 WHO. Nyeri operasi umumnya berlangsung 24 jam. Prinsip terapi nyeri akut adalah }{\i1 \fs24 \kerning2 \dbch \af0 \hi

ch \af0 \loch \f0 descending}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 the ladder. }{\i1 \fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\shp {\*\shpinst \shpleft1593 \shptop-29 \shpright6693 \shpbottom5446 \shpfhdr0 \shpbxcolumn \shpbxignore\shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz2 \shplid1028 {\sp {\sn shapeType}{\sv 75}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}}{\sp {\sn fLockVertic



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\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-316 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li2760 \ri0 \nowidctlpar \adjustrigh

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\sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page8}{\*\bkmkend page8}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 14}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-352 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl460 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Besarnya persepsi nyeri dan sensasi lain bergantung pada stimulasi dari reseptor perifer yang diikuti dengan transmisi impuls

oleh saraf sensorik melalui medula spinalis dan otak, kemudian menuju thalamus dan korteks. Persepsi nyeri dipengaruhi oleh banyak faktor, diantaranya aktivitas saraf dan perubahan intensitas stimulus. Sebagai contoh pada tangan yang di rendam pada air hangat, respon nyeri akan dipersepsikan dalam jangka waktu yang lebih lama jika dibandingkan dengan memasukkan tangan secara langsung pada air panas. Hal ini merefleksikan besarnya frekuensi impuls yang melalui saraf sensorik.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 28}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl201 \slmult1 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Patofisiologi Nyeri}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj

\li0 \ri0 \sl-272 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Tahap terjadinya nyeri adalah sebagai berikut :}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-276 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-452 \li460 \ri0 \nowidctlpar \nooverflow \adjustright \lin460 \rin0 \tql \tx460 \itap0 \ls5 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch\af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Transduksi }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hi

ch \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard\plain \qj \fi449 \li100 \ri0 \sl453 \slmult1 \nowidctlpar \nooverflow \adjustright \lin100 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Proses inflamasi akan menyebabkan teraktifasinya reseptor nyeri akibat proses kimiawi. Sensitisasi perifer dapat mengakibatkan keadaan meningkatnya ambang nyeri pada seseorang. Apabila pada rangsangan yang lemah terasa nyeri maka keadaan ini disebut dengan Allodinia. Sedangkan apabila pada rangsangan yang kuat terasa sangat nyeri, maka disebut dengan hiperalgesia. Proses transduksi dihambat oleh obat non steroid anti inflamasi.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 8}{\fs21 \kerning2 \dbch \af



3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li100 \ri0 \sl201 \slmult1 \nowidctlpar \adjustright \lin100 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 b. Transmisi}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi420 \li0 \ri0 \sl429 \slmult1 \nowidctlpar \nooverflow\adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Proses penyaluran impuls saraf sensorik dilakukan oleh serabut A delta bermielin dan serabut C tak bermielin.Impuls ini akan dilanjutkan menuju traktus}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page9}{\*\bkmkend page9}{\fs21 \kerning2 \dbch\af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 15}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \l

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erning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl419\slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch\f0 spinothalamikus, sebelum akhirnya disalurkan menuju area somatik primer di korteks serebri. Proses transmisi dapat dihambat oleh anestetik lokal di perifermaupun sentral.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 8}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-191 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \tql \tx340\itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 c.}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \tab }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Modulasi}{\fs21 \kerning2 \d

bch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-335 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi360 \li0 \ri0 \sl437 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada tahap ini impuls akan mengalami fase penyaringan intensitas di medula spinalis sebelum dilanjutkan ke korteks serebri. Modulator penghambat nyeri di medula spinalis terdiri dari analgetik endogen seperti endorfin, sistem inhibisi sentral seretonin dan noradrenalin, dan aktifitas serabut A beta.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 8}{\fs21



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28a2800a28a2800a28a2800a28a2800a28a2800a28a2800a28a2800a28a2800a28a2800aa33693a7dc1dd2d9dbbb7f78c633f9d5ea4a02f6d8cf8f45d362e56c2dc1f53183575116340a8a1547400714fa5a02edee14514500145145001451450014514500145145001451450014514500145145007fffd9}}}{\sp {\sn f3DOK}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fFilled}{\sv 0}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 0}}{\sp {\sn fBehindDocument}{\sv 1}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard\plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3\hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctl

par \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch\af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch\af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \

loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21\kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0\rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \pla

in \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar\adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \sl



mult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0\loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \

sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2\dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich\af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-325 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li2440 \ri0 \nowidctlpar \adjustright \lin2440 \rin0 \itap0 \fs21 \kerning2 \dbch \af

3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Gambar 4}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 . Jalur Modulasi Nyeri.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 29}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain\qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-354 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-712 \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \tql \tx720 \itap0 \ls7 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbc

h \af0 \hich \af0 \loch \f0 Reaksi Inflamasi }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-271 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Respon Inflamasi merupakan tahap pertama penyembuhan luka, sebelum }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-332 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \



loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl467 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 melalui tahap proliferasi dan remodelling. Pada tahap ini terjadi respon baik berupa respon vaskular maupun selular yang diperantarai oleh mediator kimia. Luka yang mengenai hingga kedalaman subkutis akan menyebabkan respon inflamasi pada jaringan ikat bervaskularisasi. Jaringan yang mengalami inflamasi memiliki ciri-ciri seperi kemerahan (}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 rubor}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 ), suhu meningkat (}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 calor}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 ), nyeri (}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 dolor}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 ) dan mampu}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page11}{\*\bkmkend page11}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2\dbch \af9 \hich \af9 \loch \f9 17}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch\f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright\lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kern

ing2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-297 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21\kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl42

5 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 mengakibatkan disfungsi organ yang bersangkutan (}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 functio laesa}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 ).}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 30}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Reaksi inflamasi berlangsung selama 2-5 hari dan terdiri dari proses hemostasis dan inflamasi. Pada proses hemostasis akan terjadi vasokontriksi pembuluh darah, pelepasan platelet, dan pembetukan sumbatan oleh trombloplastin. Sedangkan pada proses inflamasi akan terjadi vasodilatasi dan pelepasan makrofag yang memicu terjadinya fagositosis.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 31}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-46 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0

{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi780 \li0 \ri0 \sl457 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada jaringan tubuh yang luka, pembuluh darah akan segera mengalami vasokontriksi, untuk menghentikan perdarahan. Kemudian platelet akan teragregasi dan membentuk suatu sumbatan untuk mempertahankan kondisi homeostatik.Faktor koagulasi dan komplemen kaskade kan terinisiasi. Faktor intrinsik dan ekstrinsik akan mengaktifasi prothrombin dan thrombin, dimana akan terjadi konversi fibrinogen menjadi benang fibrin yang kemudian akan terpolimerisasi menjadi sumbatan yang stabil.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 32,3



3}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-11 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl447 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch\af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Saat thrombus terbentuk, hemostasis pada luka akan tercapai. Platelet yang telah teragregasi akan mengalami degranulasi, mengeluarkan kemotraktan untuk sel inflamasi, mengaktifasi faktor faktor untuk fibroblas lokal dan sel endotel, serta mengakibatkan vasokontriksi. Adesi dari platelet dipengaruhi oleh reseptor integrin, seperti GPIIb/IIIa.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 30}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-19 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl454 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Dalam beberapa menit, proses penyembuhan luka akan terinisisasi. Setelah pembuluh darah mengalami vasokontriksi, pembuluh darah lokal akan mengalami dilatasi sekunder yang diakibatkan oleh efek dari proses koagulasi dan kaskade}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700\margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endn

here \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page12}{\*\bkmkend page12}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 18}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21\kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \p

ar }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0\rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-352 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl418 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 komplemen. Bradikinin merupakan vasodilatator poten dan salah satu faktor permeabilitas vaskuler yang dibentuk oleh aktivasi faktor hageman pada kaskade koagulasi.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 32}{\fs21 \kerning2 \dbch \af3 \hich \

af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-54 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl437 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Sel darah putih akan dilepaskan dan protein plasma akan memasuki jaringan yang luka. Neutrofil akan menginfiltrasi debris, bakteri, dan jaringan lain. Aktivasi komplemen pada pembunuhan bakteri melalui proses opsonisasi. Neutrofil ini memegang peranan untuk mensterilisasi jaringan yang luka.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 32}{\fs21 \kerning2 \dbch \af3 \h



ich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-31 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl447 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Hasil akhir terbaik yang diharapkan dari proses inflamasiakut adalah resolusi total dengan regenerasi sel-sel asli dan pemulihan ke keadaan normal. Resolusi ditandai dengan adanya netralisasi dari mediator kimiawi, permeabilitas vaskular normal, dan diakhirinya hilangnya cairan dan protein di daerah edema, leukosit, partikel asing dan jaringan nekrosis di daerah inflamasi.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 34}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-712 \li720 \ri0 \sl210 \slmult1 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \tql \tx720 \itap0 \ls8 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Kortisol }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-271 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li720 \ri0\nowidctlpar \nooverflow \adjustright \lin720 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Kortisol atau yang juga dikenal dengan hidrocortisol, adalah hormon }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0\sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0

\par }\pard \plain \qj \li0 \ri0 \sl463 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 glukokortikoid utama pada manusia. Hormon ini diproduksi di zona fasikulata dari korteks adrenal. Di dalam darah hormon kortisol diikat oleh protein plasma spesifik yang disebut dengan transcortin. Hormon ini mempengaruhi tubuh melalui beberapa aksi, antara lain :}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch\af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2620 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page13}{\*\bkmkend pa

ge13}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch\f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 19}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f

0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-294 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard\plain \qj \fi-354 \li360 \ri0 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \tql \tx360 \itap0 \ls9 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Katabolisme Protein }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hi



ch \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard\plain \qj \li360 \ri0 \sl447 \slmult1 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Glukokortikoid meningkatkan katabolisme protein, terutama jaringan otot. Selain itu hormon ini juga akan memicu pelepasan asam amino menuju aliran darah, sehingga menyebabkan peningkatan konsentrasi asamamino dalam darah. Asam amino tersebut akan digunakan tubuh untuk sintesis protein yang baru atau untuk memproduksi ATP.}{\fs32 \kerning2 \dbch \af0 \hich \af0\loch \f0 \super1 35}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-352 \li360 \ri0 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \tql \tx360 \itap0 \ls9\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pembentukan Glukosa }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li360 \ri0 \sl418 \slmult1 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Hormon kortisol, akan memicu terjadinya proses glukoneogenesis. Dimanaakan terbentuk glukosa dari hasil biokimiawi oleh asam lemak dan juga asam amino.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 35}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-352 \li360 \ri0 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \tql \tx360 \itap0 \ls9 \fs21 \kerning2 \dbch \af3 \hich \af0 \

loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Efek Anti-inflamasi }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li360 \ri0 \sl418 \slmult1 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Glukokortikoid menghambat seldarah putih untuk bekerja pada respon inflamasi. Penggunaan efek ini sering digunakan untuk terapi pada pasien rhematoid artritis.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 35}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-352 \li360 \ri0 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \tql \tx360 \itap0 \ls9 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbc

h \af0 \hich \af0 \loch \f0 Depresi sistem imun }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li360 \ri0 \sl418 \slmult1 \nowidctlpar \nooverflow \adjustright \lin360 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada kadar yang tinggi, hormon kortisol dapat menekan sistemimun pada manusia. Efek ini sering dimanfaatkan bagi pasien transpantasi organ untuk mengurangi penolakan dari sistem imun.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 36}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0\loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpa

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\plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-352 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl468 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Kortisol berperan penting pada adaptasi terhadap stress. Pada keadaan stress, produksi kortisol akan dipicu sehingga kadar kortisol dalam darah akan meningkat. peningkatan kadar kortisol ini tergantung dari tingkat stress yang dialami. Stress dapat disebabkan oleh banyak hal, agen yang menginduksi terjadinya stress ini disebut dengan stressor. Terdapatbeberapa macam stressor yang dapat menginduksi stress, antara lain fisik, kimia, fisiologis, emosi, dan sosial. Stressor fisik dapat berupa trauma, pembedahan,ataupun temperatur yang sangat tinggi atau sangat rendah. Stressor kimia dapat berupa pengurangan kadar oksigen dalam darah ataupun ketidakseimbangan asam-basatubuh. Stressor fisiologis dapat dikarenakan latihan fisik yang berlebihan, syok

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ch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmu

lt0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-353 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li2960 \ri0 \nowidctlpar \adjustright \lin2960 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Gambar 5}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 . Regulasi Kortisol.}{\



fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 39}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0\loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-208 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl471 \slmult1 \nowidctlpar \nooverflow\adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada keadaan stress, seperti trauma, hipotalamus dan pituitari anterior akan merespon feedback negatif yang diakibatkan dari proses stress tersebut. Kadar kortisol yang rendah akan menstimulasi sel neurosekretori di hipotalamus untuk menghasilkan }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 corticotropin-releasing hormon}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 e (CRH). Vena porta hipofise membawa CRH ke pituitary anterior, dimana disini akan terjadi stimulasi pelepasan }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 adrenocorticotropic hormon }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 (ACTH). ACTH ini akan merangsang korteks adrenal}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\fs24 \kerning2 \dbch\af0 \hich \af0 \loch \f0 untuk mensekresi kortisol, sehingga kadar kortisol dar

ah akan meningkat. Kortisol}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page16}{\*\bkmkend page16}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 22}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3

\hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-352 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl373 \slmult1 \now

idctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3\hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 dikeluarkan untuk menginduksi suatu rangkaian efek metabolisme yang akan langsung mengurangi sifat perusakan dari keadaan stress.}{\fs32 \kerning2 \dbch \af0 \hich \af0\loch \f0 \super1 37,40}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-103 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch\af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl437 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Kad



ar kortisol plasma dalam tubuh juga dipengaruhi irama sirkandian atau disebut juga ritme diurnal. Konsentrasi kortisol plasma tertinggi terjadi pada pagi hari ketika bangun antara pukul 6.00 -8.00. Sedangkan konsentrasi kortisol plasma terendah terjadi pada waktu malam hari, sebelum tidur yaitu sekitar pukul 23.00.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 41}{\fs21 \kerning2 \dbch\af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-31 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl454 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Nilai normal kadar kortisol plasma berbeda-beda tergantung dengan spesimen yang digunakan, pada spesimen urin nilai normal kortisol adalah 20-90 mcg/hari, pada serum darah pagi hari 4-22 mcg/hari sedangkan serum darahsore hari 3-17}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-18 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2\dbch \af0 \hich \af0 \loch \f0 mcg/hari.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 39}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\shp {\*\shpinst \shpleft1488 \shptop443 \shpright7430 \shpbottom3728 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shp

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in \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar\adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-272 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li2160 \ri0 \nowidctlpar \adjustright \lin2160 \rin0\itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Gambar 6}{\fs24 \kerning2 \dbch \af0 \hich \af0 \lo



ch \f0 . Grafik konsentrasi kortisol plasma.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 39}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0\loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qj \li8060 \ri0 \sl239 \slmult1 \nowidctlpar \adjustright \lin8060 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page17}{\*\bkmkend page17}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch\f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs21 \kerning2 \dbch \af9 \hich \af9 \loch \f9 23}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2\dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich\af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \pl

ain \qj \li0 \ri0 \sl-297 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl356 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada keadaan normal kadar kortisol dalam tubuh sekitar 400 nmol litre}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 -1}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 , pada keadaan stress konsentrasinya akan meningkat hingga lebih dari 1500 nmol litre}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 -1}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 , tergantung dari berat-ringannya stress akibat trauma. Peningkatan kadar kortisol ini dapat dimodifikasi dengan intervensi obat-obat anestetik.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 4}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj

\li0 \ri0 \sl-153 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0\loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 \trowd \trql \trgaph0 \trrh82 \trleft1960 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108\trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalb \clbrdrl \brdrs \brdrw20 \clbrdrr \brdrnone \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx2080 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx3160 \clvertalb \clbrdrl \brdrnone\clbrdrr \brdrs \brdrw20 \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx3300 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4280 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4880 \clvertalb \cl

brdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx5800 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx7560 \clvertalb \clbrdrl\brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx9820 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj\li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0\cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1\itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustri



ght \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0{\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich\af0 \loch \af0 {\fs1 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl1\itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 \trowd \trql \trgaph0 \trrh82 \trleft1960 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalb \clbrdrl \brdrs \brdrw20 \clbrdrr \brdrnone \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx2080 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx3160 \clvertalb \clbrdrl \brdrnone \clbrdrr\brdrs \brdrw20 \clbrdrt \brdrs \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx3300 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4280 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4880 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb\cellx5800 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdr

s \brdrw20 \clbrdrb \brdrnone \cltxlrtb \cellx7560 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx9820 \row \pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs13 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li280 \ri0 \sl-262 \slmult0 \nowidctlpar \adjustright \lin280 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 Stress}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs13 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs13 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0

\rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs13 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs13 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li400 \ri0 \sl-262 \slmult0 \nowidctlpar \adjustright \lin400 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 Sirkandian}{\fs21 \kerning2 \dbch \af3 \hich \af0\loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs1 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 \trowd \trql \trgaph0 \trrh157 \trleft1960 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trp

addfb3 \trpaddfr3 \clvertalb \clbrdrl \brdrs \brdrw20 \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx2080 \clvmgf \clvertalb \clbrdrl\brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx3160 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx3300 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrs \brdrw20 \cltxlrtb \cellx4280 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4880 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrs \brdrw20 \cltxlrtb \cellx5800 \clvmgf \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdr



none \cltxlrtb \cellx7560 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx9820 \row \pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright\lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs7 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain\qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs1 \kerning2 \dbch \af3 \hich \af0 \loch\f0 \cell }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright\lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 \trowd \trql \trgaph0 \trrh86 \trleft1960 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalb \c

lbrdrl \brdrs \brdrw20 \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone\cltxlrtb \cellx2080 \clvmrg \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx3160 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb\cellx3300 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4280 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4880 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone\cltxlrtb \cellx5800 \clvmrg \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx7560 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb\cellx9820 \row \pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2

\dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar\adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1

\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs4 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs1 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 \trowd \trql \trgaph0 \trrh47 \trleft1960 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalb \clbrdrl \brdrs \brdrw20 \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx2080 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cell



x3160 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone\clbrdrb \brdrnone \cltxlrtb \cellx3300 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4280 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx4880 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrs \brdrw20 \clbrdrt\brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx5800 \clvertalb \clbrdrl \brdrnone\clbrdrr \brdrs \brdrw20 \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx7560 \clvertalb \clbrdrl \brdrnone \clbrdrr \brdrnone \clbrdrt \brdrnone \clbrdrb \brdrnone \cltxlrtb \cellx9820 \row \pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs6 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs6 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs6 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs6 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0\nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3\hich \af0 \loch \af0 {\fs6 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs6 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \cell }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0\rin0 \intbl1 \itap1 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs6 \ker

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af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Peningkatan kadar kortisol ini bertujuan untuk memicu produksi glukosa. Glukosa yangakan terbentuk ini pada akhirnya akan digunakan untuk meningkatkan suplai glukosa darah ke otak untuk mencegah terjadinya malnutrisi pada organ}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn709 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page18}{\*\bkmkend page18}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \

'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9 \loch \f9 24}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch



\af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-294 \slmult0\nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \tql \tx1500 \itap0 \fs21\kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 vital.Kortisol}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \tab }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 akan menginduksi proteolis pada otot rangkasehingga akan}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-262 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21\kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 meyebabkan lepasnya laktat ke dalam darah.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 1}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-202 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2\dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-712 \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \tql \tx720 \itap0 \ls10 \fs21 \kerning2 \dbch \af3 \hich \af0\loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Insisi }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \s

l-271 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Insisi merupakan tindakan bedah yang dilakukan pada kulit dan jaringan sub }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-335 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl457 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0kutikuler. Tindakan ini dilakukan untuk menghasilkan luka derajat ringan hinggasedang dengan menggunakan pisau tajam. Tujuan dari insisi adalah untuk menunjukk

an jaringan dalam tubuh, tulang, ataupun organ. Dalam melakukan insisi, derajatluka yang akan dihasilkan tergantung dari lebar dan kedalaman dari penyayatan. Insisi terbuka banyak digunakan dalam dunia pembedahan. Teknik insisi terbaru, seperti laparoskopi, mampu meminimalisir luka invasive dimana luka yang dihasilkan kecil namun cukup muat untuk dimasuki intrumen pembedahan ke dalam tubuh. Walaupun insisi tergolong tindakan bedah, tindakan ini berbeda dengan pembedahan pada umumnya dimana insisi biasa dilakukan di kulit luar, memiliki potensi komplikasi yang kecil, proses penyembuhan yang cepat, serta jaringan parut yang sedikit.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 42}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Insisi tergolong tindakan yang dapat menyebabkan trauma atau stress pada pasien. Stress yang disebabkan ini dapat merangsang sistem HPA aksis untuk meregulasi pelepasan kadar kortisol, sehingga dapat menyebabkan peningkatan kadar kortisol pada darah.}{\fs32 \kerning2 \dbch \af0 \hich \af0

\loch \f0 \super1 43}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \sect }\sectd \sbkpage \pgwsxn12240 \pghsxn15840 \marglsxn2260 \margrsxn1700 \margtsxn697 \margbsxn1440 \guttersxn0 \headery720 \footery720 \pgbrdropt0 \endnhere \pard \plain \qr \li0 \ri0 \sl239 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\*\bkmkstart page19}{\*\bkmkend page19}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs22 \kerning2 \dbch \af9 \hich \af9



\loch \f9 25}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich\af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-200 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-298 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi-712 \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \tql \tx720 \itap0 \ls11 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pengaruh Pemberian Analgesik Terhadap Kadar Kortisol }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-271 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li720 \ri0 \nowidctlpar \nooverflow \adjustright \lin720 \rin0 \itap0\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hi

ch \af0 \loch \f0 Pemberian obat-obat anestesi, terutama obat analgesik telah lama diketahui }{\b1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-334 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl437 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 dapat menurunkan kadar kortisol darah. Obat analgesik golongan opioid mampu menekan kerja dari hipotamalus dan pituitari, sehingga produksi hormon terhambat. Obat analgesik mampu menghambat pelepasan dari kortikotropin dan kortisol, walaupun respon dari peningkatan ACTH masih ada.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 4}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl-31 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerni

ng2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl447 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada pembedahan jantung, pemberian dosis besar morfin dapat memblok sekresi growth hormon dan menghambat pelepasan hormon kortisol sampai onset dari }{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 cardiopulmonary bypass }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 (CBP). Beberapa obat golongan opioid seperti, fentanil, dan}{\i1 \fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 }{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 alfentamil mampu menekan sekresi hormon pituitari sampai CBP. Setelah onset dari CBP, potensi kerja obat opioid tidak akan mampu bekerja secara maksimal lagi. }{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 4}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \s

l-19 \slmult0 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \fi720 \li0 \ri0 \sl451 \slmult1 \nowidctlpar \nooverflow \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pada pemberian analgesik regional secara epidural, terbukti mampu mencegah respon endokrin dan metabolik terhadap pembedahan di pelvis dan ekstremitas bawah.. Pemberian analgesik secara epidural baik afferen, stimulus dari luka operasi hingga sistem saraf pusat dan aksishipotalamus-pituitary, dan eferen jalur saraf menuju adrenal diblok. Sehingga menyebabkan respon glikemik dan adrenokortikal tidak bekerja. }{\fs32 \kerning2 \d



bch \af0 \hich \af0 \loch \f0 \super1 4}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 Pemberian analgesik golongan opioid juga terbukti efektif dalam mengatasi nyeri akibat neuropati. Penekanan nyeri ini akan menghambat pelepasan}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }\pard \plain \qj \li0 \ri0 \sl233 \slmult1 \nowidctlpar \adjustright \lin0 \rin0 \itap0 \fs21 \kerning2 \dbch \af3 \hich \af0 \loch \af0 {\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \'0a}{\fs24 \kerning2 \dbch \af0 \hich \af0 \loch \f0 kortisol.}{\fs32 \kerning2 \dbch \af0 \hich \af0 \loch \f0 \super1 44}{\fs21 \kerning2 \dbch \af3 \hich \af0 \loch \f0 \par }}

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analgesik opiodi dan non opioid