Meta-analysis Of The Efficacy Of Continuous Veno-venous Hemofiltration Combined With Hemoperfusion In The Treatment Of Paraquat Poisoning

Objective:To elevate the efficacy of continuous veno-venous hemofiltration in the treatment of paraquat poisoning.Methods:Random clinical trials(RCTs)literatures of which continuous veno-venous hemofiltration was used to treat paraquat poisoning were collected by computer retrieval combined with manual screening,from PubMed,EMbase,the Cochrane library,SinoMed,Web of science,CNKI and Wanfang databases.The latest search on December 31th,2017.The data included the mortality rates,the survival time,the incidence of respiratory failure,the incidence of circulatory failure.The bias risk of the included studies was evaluated by Cochrane Handbook.All data were analyzed using the RevMan 5.3 software,the heterogeneity of the studies was analyzed using the chi-square test and I~2 test,and fixed effect or random effect model was used to calculate the combined effect.Results:six literatures were enrolled in the study,including 1117 cases of paraquat poisoning.There were 425 patients in the hemoperfusion combined with continuous veno-venous hemofiltration group and 692 patients in the hemoperfusion group.The results of Meta-analysis:compared with HP group,HP+CVVH can decreased the mortality of 3/4 days(RR=0.63,95%CI:[0.50,0.79],P<0.05),and there were no significant difference in the mortality rate of 28/30 days,90 days and the total mortality rate between two groups(RR=0.81,1.05,1.02;95%CI:[0.59,1.11],[0.83,1.32],[0.90,1.16];P>0.05).HP+CVVH can prolong survival time of patients(MD=2.82,95%CI:[2.47,3.17],P<0.05),increase the incidence of respiratory failure(RR=2.75,95%CI:[2.18,3.48],P<0.05),and reduce the incidence of circulatory failure(RR=0.40,95%CI:[0.30,0.52],P<0.05)Conclusions:continuous veno-venous hemofiltration can reduce the short-term mortality,prolong the survival time of patients,and buy some time for further rescue,but there is no statistical difference in long-term mortality.Meanwhile,it was also found that continuous veno-venous hemofiltration could reduce the incidence of circulatory failure,but could not alleviate the lung injury caused by PQ and reduce the incidence of respiratory failure.