| Objective(s):The purpose of this study is to construct a lung rehabilitation program for ARDS patients based on bedside ultrasound by evidence-based means and case study,and explore the practical effect of this program in clinical practice,with a view to providing guidance for lung rehabilitation nursing of clinical ARDS patients,reducing the time of ventilator support and hospitalization for ARDS patients,saving medical costs,improving the quality of life of ARDS patients,and speeding up the time of patients’ active rehabilitation exercise intervention.Methods:The case study method was used to investigate the lung rehabilitation nursing of ARDS patients,collect the patients with ARDS who were admitted to a Class III A comprehensive intensive care department in Kunming from November 2021 to June2022,and identify the problems in the lung rehabilitation of ARDS at the present stage through case analysis.Follow the evidence-based nursing method,through literature research,combined with the case study results and the actual situation,construct the first draft of the rehabilitation plan through group brainstorming,and finally complete the lung rehabilitation plan for ARDS patients based on bedside ultrasound through expert correspondence.The rehabilitation scheme of ARDS patients based on bedside ultrasound was clinically verified by the quasi-experimental research method.Using the convenient sampling method,the patients with ARDS who were admitted to a Class III A comprehensive intensive care department in Kunming were taken as the study object;In order to avoid contamination of the two groups of patients when implementing the lung rehabilitation program,57 patients with ARDS were selected from the previous collection and 30 patients were selected as the control group by digital random method,and 30 patients who met the conditions for inclusion from July 2022 to December 2022 were selected as the experimental group.Both the control group and the experimental group received routine treatment;The control group received routine lung rehabilitation;The experimental group received the lung rehabilitation program of ARDS patients based on bedside ultrasound.Taking the length of stay as the main outcome index,the respiratory muscle condition,the time of ventilator support,the start time of active rehabilitation exercise and the change of respiratory muscle thickness were compared.SPSS 25.0 statistical software was used to evaluate the implementation effect of lung rehabilitation program for ARDS patients under bedside ultrasound by using chi-square test,t-test,rank sum test and other analysis data.Results:From December 2021 to June 2022,57 patients with ARDS were admitted to three hospitals in Kunming City,with an average age of 62.84 ± 12.96 years,including 38 males(66.67%)and 19 females(33.33%).Patient survival: 25;Death:21 people;Automatic discharge: 11 people,except for automatic discharge,the mortality rate of patients is 45.65%.Grading of ARDS: mild: 14 moderate: 24 severe:19;Classification of ARDS: Intrapulmonary type: 22(70.59%),extrapulmonary type:35(31.03%).All patients received conventional treatment and conventional lung rehabilitation.During the study,it was found that the following problems exist in the lung rehabilitation of ARDS patients at the current stage:(1)The rehabilitation implementer lacks appropriate tools to evaluate the lung rehabilitation status of ARDS patients;(2)There are no relevant regulatory requirements for starting the lung rehabilitation time of patients with ARDS;(3)The rehabilitation implementers lack specific guidance from relevant disciplines;(4)No clear indicators of rehabilitation activities;(5)Lack of evaluation mechanism during and after rehabilitation(6)Lack of clinical medical resources and supervision by managers.Research results of literature related to lung rehabilitation for ARDS patients: A total of 15 randomized controlled research articles were included for meta-analysis,and combined with clinical practice,a lung rehabilitation plan for ARDS patients based on bedside ultrasound was determined through expert consultation.According to random sampling,30 patients in the control group were obtained,including 17 males and 13 females,aged 63.60 ± 19.39 years,and BMI: 23.54 ± 3.31.ARDS was classified according to intrapulmonary and extrapulmonary classification(intrapulmonary,extrapulmonary),and ARDS was classified according to the Berlin definition(mild,moderate,and severe).Thirty patients in the experimental group were collected,including 19 males and 11 females;The average age of the patient was 59.83 ± 17.74 years old.Comparative analysis showed that there was a difference in lung ultrasound scores between the two groups on the 4th and 7th days(P<0.05).The lung ultrasound scores in the experimental group were lower than those in the control group.There was a difference in oxygenation index between the two groups on the 4th day(P<0.05);On the 7th day,there was no significant difference in oxygenation index,P=0.8.The use of bedside ultrasound based lung rehabilitation programs for patients with ARDS can reduce the number of days of ICU hospitalization and ventilator use time of patients(P<0.05).Through this lung rehabilitation program,the patient’s active activity intervention time was advanced(P;There was no significant difference between the control group and the experimental group in the degree of decline of the pectoral and intercostal muscles of the patients(P>0.05).Conclusions:The lung rehabilitation plan for ARDS patients based on bedside ultrasound developed in this study has a positive effect on reducing the hospitalization time of patients,reducing the time of ventilator support,reducing the respiratory muscle consumption of patients,improving the early oxygenation index of patients,improving the lung ultrasound score of patients,and speeding up the intervention time of active rehabilitation exercise of patients.The program has good clinical promotion value;However,this study lacks continuous follow-up results and needs further study. |
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