Verifica clinica del percorso latex-safe:
PAZIENTE EtCO
T1 mmHg EtCO2 T2 mmHg EtCO2 T3 mmHg EtCO2 media mmHg ∆ EtCO2 SaO2 T1 % SaO2 T2 % SaO2 T3 % SaO2 medio % ∆ SaO2 latex-safe 30 30 30 30 0 100 100 100 100 0 latex-safe 26 28 30 28 1,3 100 100 100 100 0 latex-safe 30 29 29 29,3 0,43 100 100 100 100 latex-safe 28 29 29 28,67 0,4 100 100 100 100 0 latex-safe 30 30 30 30 0 100 100 100 100 0 latex-safe 29 30 28 29 0,66 100 100 100 100 0 latex-safe 30 30 30 30 0 100 100 100 100 0 latex-safe 31 30 29 30 0,66 100 100 100 100 0 latex-safe 29 29 29 29 0 100 100 100 100 0 latex-safe 34 34 34 34 0 100 100 100 100 0 latex-safe 36 32 31 33 2 100 100 100 100 0 latex-safe 28 28 28 28 0 100 100 100 100 0 latex-safe 32 32 32 32 0 100 100 100 100 0 latex-safe 35 34 35 34,6 0,4 100 100 100 100 0 latex-safe 30 31 30 30,3 0,4 100 100 100 100 0 latex-safe 28 28 28 28 0 100 100 100 100 0 latex-safe 31 31 31 31 0 100 100 100 100 0 latex-safe 34 34 34 34 0 100 100 100 100 0 latex-safe 30 28 30 29,3 0,9 100 100 100 100 0 latex-safe 35 32 31 32,6 1,53 100 100 100 100 0 latex-safe 33 33 33 33 0 100 100 100 100 0 latex-safe 33 33 33 33 0 100 100 100 100 0 latex-safe 32 32 32 32 0 100 100 100 100 0 latex-safe 31 33 33 32,3 0,8 100 100 100 100 0 latex-safe 33 32 31 32 0,6 100 100 100 100 0 latex-safe 39 39 39 39 0 100 100 100 100 0 latex-safe 36 36 36 36 0 100 100 100 100 0 latex-safe 30 29 29 29,3 0,4 100 100 100 100 0 latex-safe 31 33 33 32,3 0,9 100 100 100 100 0 latex-safe 31 30 30 30,3 0,4 100 100 100 100 0 latex-safe 27 28 27 27,3 0,4 100 100 100 100 0 0
latex-safe 35 35 35 35 0 100 100 100 100 0 latex-safe 31 31 31 31 0 100 100 100 100 0 latex-safe 38 33 35 35,3 1,7 100 100 100 100 0 latex-safe 33 34 35 34 0,6 100 100 100 100 0 latex-safe 30 30 30 30 0 100 100 100 100 0 latex-safe 27 27 27 27 0 100 100 100 100 0 latex-safe 29 30 30 29,6 0,4 100 100 100 100 0 latex-safe 29 30 30 29,6 0,4 100 100 100 100 0 latex-safe 35 35 35 35 0 100 100 100 100 0 latex-safe 33 33 33 33 0 100 100 100 100 0 latex-safe 28 30 30 29,3 0,9 100 100 100 100 0 latex-safe 30 35 35 33,3 2,2 100 100 100 100 0 latex-safe 30 34 31 31,7 1,6 100 100 100 100 0 latex-safe 33 30 29 30,7 1,6 100 100 100 100 0 latex-safe 30 30 30 30,0 0,0 100 100 100 100 0 non latex-safe 31 31 31 31,0 0,0 100 100 100 100 0 non latex-safe 33 33 33 33,0 0,0 100 100 100 100 0 non latex-safe 32 32 32 32,0 0,0 100 100 100 100 0 non latex-safe 27 27 27 27,0 0,0 100 100 100 100 0 non latex-safe 32 32 32 32,0 0,0 100 100 100 100 0 non latex-safe 33 33 33 33,0 0,0 100 100 100 100 0 non latex-safe 33 32 33 32,7 0,4 100 100 100 100 0 non latex-safe 32 32 32 32,0 0,0 100 100 100 100 0 non latex-safe 41 40 38 39,7 1,1 100 100 100 100 0 non latex-safe 26 26 28 26,7 0,9 100 100 100 100 0 non latex-safe 30 27 29 28,7 1,1 100 100 100 100 0 non latex-safe 30 30 30 30,0 0,0 100 100 100 100 0 non latex-safe 30 30 30 30,0 0,0 100 100 100 100 0 non latex-safe 26 28 27 27,0 0,7 100 100 100 100 0 non latex-safe 30 29 30 29,7 0,4 100 100 100 100 0 non latex-safe 28 27 27 27,3 0,4 100 100 100 100 0 non latex-safe 30 28 29 29,0 0,7 100 100 100 100 0 non latex-safe 29 29 29 29,0 0,0 100 100 100 100 0 non latex-safe 31 30 32 31,0 0,7 100 100 100 100 0 non latex-safe 34 34 34 34,0 0,0 100 100 100 100 0 non latex-safe 36 34 33 34,3 1,1 100 100 100 100 0 non latex-safe 35 33 35 34,3 0,9 100 100 100 100 0 non latex-safe 30 31 30 30,3 0,4 100 100 100 100 0 non latex-safe 28 28 28 28,0 0,0 100 100 100 100 0 non latex-safe 31 29 28 29,3 1,1 100 100 100 100 0 non latex-safe 33 32 31 32,0 0,7 100 100 100 100 0 non latex-safe 39 39 37 38,3 0,9 100 100 100 100 0 non latex-safe 36 36 36 36,0 0,0 100 100 100 100 0 non latex-safe 30 28 28 28,7 0,9 100 100 100 100 0 non latex-safe 30 30 29 29,7 0,4 100 100 100 100 0 non latex-safe 32 32 32 32,0 0,0 100 100 100 100 0 non latex-safe 31 30 30 30,3 0,4 100 100 100 100 0 non latex-safe 31 33 33 32,3 0,9 100 100 100 100 0 non latex-safe 27 28 27 27,3 0,4 100 100 100 100 0 non latex-safe 27 27 27 27,0 0,0 100 100 100 100 0 non latex-safe 29 30 30 29,7 0,4 100 100 100 100 0 non latex-safe 29 30 30 29,7 0,4 100 100 100 100 0 non latex-safe 31 30 28 29,7 1,1 100 100 100 100 0
non latex-safe 38 33 35 35,3 1,8 100 100 100 100 0 non latex-safe 34 30 30 31,3 1,8 100 100 100 100 0 non latex-safe 35 31 38 34,7 2,4 100 100 100 100 0 non latex-safe 41 38 38 39,0 1,3 100 100 100 100 0 non latex-safe 28 28 28 28,0 0,0 100 100 100 100 0 non latex-safe 31 30 29 30,0 0,7 100 100 100 100 0 non latex-safe 29 28 31 29,3 1,1 100 100 100 100 0 non latex-safe 31 30 28 29,7 1,1 100 100 100 100 0
Tabella 6: Valori di: EtCO2 e di SaO2 ai tempi T1,T2,T3; valore medio di EtCO2 e di SaO2; e valore della variazione media di EtCO2 e di SaO2.
Parametro Valore t p
∆ medio PAM 0,774337227 non significativo
∆ medio FC 0,25316588 non significativo
∆ EtcO2 0,34656365 non significativo
Tabella 7: Esito del test t di Student
Degenza totale:
La degenza totale dei 69 pazienti sottoposti a percorso latex-safe è stata confrontata con i valori di degenza totale media prevista dal DRG aziendale per ogni specifico intervento eseguito dai pazienti in esame (tab.8), non si fa quindi riferimento ai controlli usati per la valutazione del decorso intraoperatorio. I pazienti studiati presentano una degenza che rientra nel range di giorni previsto dal DRG aziendale (fig.16). Quattro pazienti hanno invece avuto un decorso di durata maggiore rispetto alla media. In ogni caso ulteriori indagini hanno permesso di constatare che ciò che ha determinato l’aumento delle durata della degenza non è comunque attribuibile all’allergia al lattice.
Paziente Degenza totale (gg) Degenza totale media secondo DRG (gg)
S. L. 1 3,60 C. M. 1 3,60 G. R. 1 3,60 M. G. 1 3,60 B. A. 1 4,42 G. M. 1 4,63 F. A. 1 3,60 L. A. 1 3,60 B. E. 1 3,25 L. G. 2 3,60 C. S. 1 3,60 B. F. 1 3,60 S. F. 1 3,60
M. S. 1 3,60 F.A. 1 3,60 B.A. 1 3,25 P.D. 1 3,60 C. M. 3 8,87 V. M. 7 7,63 L.M. 3 4,58 C. S. 5 4,58 G.I. 1 4,58 L.M.C. 2 4,58 M.C. 3 4,58 L.L. 1 4,58 A.F. 2 3,29 S.L. 2 3,29 A.J. 2 3,29 P.F. 2 3,29 G.R. 4 6,29 G.M. 4 6,29 L.G. 8 11,55 S.F. 1 5,24 G.E. 7 8,56 D.R.F 43 9,89 T.S. 1 2,13 C.C. 8 18,26 L.F. 1 2,85 G. T. 8 18,26 C. F. 3 3,60 A. M. C. 3 3,60 B. C. 2 3,60 M. N. G. 2 2,50 P. N. 2 4,63 M. S. 3 4,42 R. A. 1 2,50 C. C. 1 2,63 P. M. 1 4,63 B. L. 1 4,13 C. C. 2 4,63 C. R. 4 4,10 G. A. G. 2 4,10 B. R. 3 4,10 F. A. 4 4,10
F. F. 3 4,62 R. C. 7 5,50 R. C. 14 18,50 R. C. 7 5,50 T. E. 1 3,33 B. M. N. 2 4,63 C.F. 13 11,94 F.A. 3 4,63 M.E. 1 3,25 M.B. 2 3,29 M.Z. 4 5,17 R.D.A. 15 18,26 P.F. 1 3,60 G.T. 1 3,60 C.S. 2 3,66
Tabella 8: degenza totale dei pazienti sottoposti a percorso latex-safe, messa a confronto con la degenza media prevista dai DRG della A.O.U.P.
0 5 10 15 20 25 30 35 40 45 50 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 Degenza totale (gg) Degenza media secondo DRG (gg)
Figura 16: curve rappresentanti la degenza totale dei pazienti sottoposti a percorso latex-safe e la degenza totale media prevista dal DRG aziendale.
Conclusioni:
Il test t di Student ha evidenziato che non esistono differenze statisticamente significative tra casi e controlli nell’ambito dei parametri considerati. Pertanto questo studio evidenzia che grazie all’applicazione del percorso latex-safe, nell’ambito del campione oggetto di studio, il paziente allergico al lattice è
sovrapponibile ad un paziente non allergico in termini di decorso intraoperatorio, indipendentemente dal tipo di intervento chirurgico eseguito, dal tipo di di premedicazione e di tecnica anestesiologica utilizzata.
Inoltre la degenza totale non varia rispetto ai giorni di degenza medi previsti dal sistema DRG aziendale per ogni specifico tipo di intervento chirurgico, evidenziando presumibilmente un regolare decorso postoperatorio. L’attuazione della percorso latex-safe risulta essere un adeguato approccio per proteggere il paziente allergico dai rischi che corre all’interno di una comune sala operatoria. Allo stesso tempo questo studio non vuole rappresentare la risposta definitiva al problema dell’allergia al lattice, ma si propone di essere un “work in progress”, nell’attuale flusso di ricerche indirizzate sia ad un utilizzo più razionale del lattice che all’adeguata modalità di approccio nei confronti del paziente allergico al lattice.
Oggi, a circa trenta anni dalla diffusione globale del lattice, è possibile rilevare i benefici di questa sostanza per le sue peculiari caratteristiche d’uso, ma allo stesso tempo è possibile una accurata stima del rischio che il lattice impone, principalmente in ambito sanitario. Ancora lontani da una sanità latex-free, nonostante l’esistenza di prodotti alternativi come il vinile, è bene guardare al futuro attraverso la messa a punto di approcci interni alla struttura sanitaria, che consentano di arginare il problema dell’ allergia al lattice.
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