Pengaruh Threshold Inspiratory Muscle Training Praoperasi terhadap Kebugaran Kardiorespirasi Pascabedah Ganti Katup Jantung

Latar Belakang: Penyakit katup jantung memberikan beban kesehatan yang besar di seluruh dunia. Pasien yang menjalani bedah ganti katup jantung di RSUP Dr. Kariadi Semarang pada tahun 2018 adalah sebanyak 111 pasien. Pada pasien pasca bedah ganti katup jantung terjadi penurunan kebugaran kardiorespirasi. Kebugaran kardiorespirasi dapat diukur melalui pengukuran VO2max. Penambahan threshold inspiratory muscle training (Threshold IMT) praoperasi dianggap mampu menaikkan baseline kebugaran kardiorespirasi sehingga hasil keluaran pascabedah menjadi lebih baik, menurunkan risiko dan komplikasi operasi serta mempersingkat waktu pemulihan dan lama perawatan. Tujuan: Mengetahui pengaruh penambahan Threshold IMT praoperasi terhadap kebugaran kardiorespirasi pasien pascabedah ganti katup jantung. Metode: Penelitian ini merupakan penelitian quasi experimental. Pengambilan sampel penelitian dilakukan secara consecutive sampling, subyek dibagi menjadi kelompok perlakuan (n=9) dan kelompok kontrol (n=9). Kelompok perlakuan diberikan latihan rehabilitasi medik konvensional rutin sebelum bedah ganti katup jantung sesuai dengan Panduan Praktik Klinis (PPK) serta ditambahkan Threshold IMT sesuai protokol penelitian. Kelompok kontrol hanya melakukan latihan rehabilitasi medik konvensional. Hasil: Terdapat perbedaan yang bermakna secara klinis antar kelompok perlakuan dan kontrol pascabedah dengan minimal clinically important difference lebih dari 6%. Terdapat perbedaan yang bermakna secara statistik untuk nilai VO2max pra dan pascaperlakuan dalam kelompok perlakuan (p=0,021), serta antar kelompok perlakuan dan kontrol pascaperlakuan (p=0,026). Kesimpulan: Penambahan Threshold IMT praoperasi meningkatkan kebugaran kardiorespirasi pasien pra dan pascabedah ganti katup jantung. Kata kunci: Threshold inspiratory muscle training, VO2max.   Background: Heart valve disease presents a huge health burden worldwide. Patients who underwent cardiac valve replacement surgery at RSUP Dr. Kariadi Semarang in 2018 were 111 patients. Cardiorespiratory fitness declined in post-surgical patients. Cardiorespiratory fitness can be measured through VO2max. Additional preoperative threshold inspiratory muscle training (Threshold IMT) is considered to safely increase cardiorespiratory fitness baseline, reduce the risks and complications of surgery as well as shorter recovery time and treatment duration, thus postoperative outcomes will be better. Objective: To determine the effect of additional preoperative Threshold IMT on cardiorespiratory fitness in post heart valve replacement surgery patients. Method: This study is quasi experimental. Sampling was done by consecutive sampling, subjects were divided into two groups, intervention group (n=9) and control group (n=9). The intervention group was given routine conventional medical rehabilitation exercise before heart valve replacement surgery according to the Clinical Practice Guide (PPK) and added Threshold IMT according to the study protocol. The control group only did conventional medical rehabilitation exercises. Results: There was clinically significant difference post surgery between intervention and control groups with minimal clinically important difference of more than 6%. Statistically significant differences were obtained for the VO2max values ??pre and post treatment in the intervention group (p = 0.021) and between the intervention and control groups (p = 0.026) post-treatment. Conclusion: Addition of preoperative Threshold IMT increases cardiorespiratory fitness pre- and post-operative in heart valve replacement surgery patients. Keyword: Threshold inspiratory muscle training, VO2max.