| Objective: Blood purification is another treatment for acute severe pancreatitis(SAP)in recent years,but there is still some controversy about its application in the treatment of SAP,in order to objectively evaluate the clinical efficacy of SAP in the early stage of blood purification treatment.The Cochrane systematic review method was used to systematically and meta-analyze the results of existing clinical trials at home and abroad,in order to provide reliable evidence for the clinical treatment of early SAP.Methods: Computer search of the Cochrane Central Register of Controlled Trials-CENTRAL,Medline,Pubmed,Embase,ISI,OVID database,China Knowledge Network Database(CNKI),Chinese Biomedicine Literature database(CBMDisc),VIP Chinese database,Chinese journal full-text database,Wanfang dissertation database,manual search of 5 relevant Chinese periodicals,related conference proceedings and all references to retrieved trials,collecting blood purification treatment SAP random For clinical controlled trials,Chinese search terms include: blood purification,hemofiltration,blood adsorption,blood exchange,hemodialysis,blood replacement,blood perfusion,and acute pancreatitis.English search terms include: Acute Pancreatitis,Hemofiltration,Renal Dialysis,Hemodiafiltration,Serum adsorption,Plasmapheresis,Serum exchange,Hemodialysis,Dialysis,and the like.The search time was from the establishment of the library to May 2018.The quality of the randomized controlled trials that met the inclusion criteria were independently evaluated by the two investigators.The mortality,cure rate,time to disappear after abdominal pain,length of hospital stay,rate of surgery,APACHE II score,and SAP complication rate were observed.The data is extracted and cross-checked.If there is a disagreement,discuss it or help with a third researcher.Finally,data synthesis was performed on the included studies.Statistical analysis was performed using Revman 5.3 software,and the relative risk(RR)or odds ratio(OR)and its 95% confidence interval(95% CI)were calculated for the count data.Mean difference or normalized mean difference and its 95% confidence interval.Result: The final 8 articles were included in the study,a total of 388 cases,including 207 in the blood purification group and 181 in the normal control group.The results showed that blood purification significantly improved the cure rate compared with the conventional control group [RR=1.18,95% CI(1.05,1.34),P=0.007],reducing the mortality rate [RR=0.54,95% CI(0.30,0.97),P=0.04],,shortening the disappearance time of abdominal pain [MD=-85.68,95% CI(-103.72),-67.63),P < 0.001],shortened hospital stay [MD =-14.84,95% CI(-28.96,-0.72),P = 0.04],decreased APACHE II score [MD =-2.14,95% CI(-3.73,-0.54),P < 0.001].There was no significant difference in the rate of conversion between the two groups [ RR = 0.60,95% CI(0.21,1.74),P = 0.35] and the incidence of SAP complications [ RR=0.37,95%CI(0.12,1.12),P=0.08].Conclusion: Acute severe pancreatitis has attracted the attention of health care workers due to its high morbidity,high complication rate and mortality.Blood purification is a treatment that has emerged in recent years,and the technology is becoming more mature.This study obtained through meta-analysis: Early blood purification treatment SAP has certain advantages in cure rate,APACHE II score and reduction of mortality,and can also shorten the time of disappearance of abdominal pain and hospitalization time.However,we have included fewer studies,less sample size,and lower quality.Therefore,the above results need to be treated with caution,and more high-quality large-sample studies are needed for further evaluation. |
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