Peran Fisioterapi pada Myastenia Gravis Paska Tymectomy
Role of Physiotherapy in Patient with Myasthenia Gravis post Thymectomy
DOI:
https://doi.org/10.36408/mhjcm.v9i3.599Keywords:
fisioterapi, myastenia gravis, thymectomy, kelemahan ototAbstract
LATAR BELAKANG : Myastenia gravis (MG) merupakan penyakit autoimun yang disebabkan akibat timbulnya antibody terhadap reseptor asetilkolin esterase (AChR) pada neuromuscular junction yang menimbulkan kelemahan otot okular, bulbar, respirasi, aksial dan ekstremitas. Berdasarkan rekomendasi, rehabilitasi memiliki peran penting dalam pencegahan dari komplikasi MG seperti kontraktur dan kegagalan pernapasan. Namun, pada MG akan terjadi kelemahan otot dengan latihan fisis dan penggunaan otot secara repetitive yang menyebabkan dokter menjadi ragu untuk merekomendasikan rehabilitasi medik pada pasien MG. Tujuan dari laporan kasus ini adalah untuk mengetahui peran rehabilitasi medik pada pasien MG.
PRESENTASI KASUS : Pasien laki-laki 20 tahun dengan MG paska operasi video-assisted thoracoscopic surgery (VATS) thymectomy. Operasi berjalan lancar dan program rehabilitasi dilakukan pada hari kedua perawatan dengan supervisi dokter rehabilitasi medik dengan program: latihan pernapasan, latihan peregangan anggota gerak, dan relaksasi selama 30 menit pagi hari. Pada hari ke-3 pasien mengalami perburukan klinis sehingga terpasang ventilator mekanik. Pada hari berikutnya kondisi pasien membaik dan program rehabilitasi dilanjutkan setelah kesadaran pasien membaik sebanyak 2x dalam sehari dengan durasi 30-60 menit. Kondisi pasien berangsur membaik dan pada hari ke-10 pasien dipulangkan dengan bantuan oksigenasi ResMed.
PEMBAHASAN: Pada pasien dengan MG generalisata dan gangguan sistem respirasi, pelatihan otot respirasi terbukti efektif untuk menangani kelemahan otot akibat fatigue atau kegagalan pernasasan. Manfaat dari latihan pernapasan tidak hanya berupa peningkatan kekuatan otot respirasi, ketahanan pernapasan dan performa fisis, namun juga penurunan dari beberapa komplikasi MG dan meningkatkan kualitas hidup pasien. Pada pasien MG paska operasi, latihan dapat dengan aman dilakukan segera setelah terekstubasi dengan supervisi dokter rehabilitasi medik.
SIMPULAN: Fisioterapi bermanfaat pada pasien MG paska thymectomy. Program rehabilitasi medik sebaiknya dirancang sesuai dengan kondisi pasien MG dan dilakukan dalam supervisi dokter rehabilitasi medik.
KATA KUNCI: fisioterapi, myastenia gravis, thymectomy, kelemahan otot
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