Meta-Analysis Of Hemoperfusion Combined With Hemodialysis And Hemoperfusion Alone For Acute Paraquat Poisoning

Objective:To evaluate the clinical efficacy of hemoperfusion combined with hemodialysis(HP+HD)and hemoperfusion(HP)alone in the treatment of acute paraquat(PQ)poisoning,and provide a reference for the selection of blood purification schemes for treatment of patients with PQ poisoning.Methods:Computers were used to search PubMed,Embase,Cochrane library,Web of science,CBM,CNKI,Wangfang,and VIP database.The retrieval time limit was from the establishment of the database to November 30,2019.All of the published articles which explored the clinical efficacy of HP combined with HD and HP alone in the treatment of acute PQ poisoning were collected.Two researchers independently screened the literature in strict accordance with the established inclusion and exclusion criteria,extracted the required data and materials,and used the Cochrane Risk Bias Assessment Tool and the Newcastle-Ottawa Scale(NOS)to evaluate the quality of randomized controlled trials(RCT)and cohort study,respectively.Meta-analysis was performed using Review Manage 5.3 software.Outcome indicators were the total efficiency,mortality,serum alanine lminotransferase,serum creatinine and arterial partial pressure of oxygen.Results:A total of 22 articles were included in this study,with a total sample size of 1258 cases,624 patients in the group of HP combined with HD and 634 patients in the group of HP alone.The results of meta-analysis showed that compared with HP alone group,HP combined with HD group had higher total efficiency(OR=3.12,95%CI:2.24~4.36,P<0.00001),lower mortality(OR=0.47,95%CI:0.32~0.69,P=0.0001),lower serum alanine lminotransferase(SMD=-3.35,95%CI:-4.52~-2.18,P<0.00001),lower serum creatinine(SMD=-3.88,95%CI:-5.22~-2.53,P<0.00001).Conclusion:(1)HP combined with HD can improve the total efficiency,reduce mortality,and reduce liver and kidney damage caused by PQ compared with HP alone in patients with acute PQ poisoning.(2)HP combined with HD is superior to HP alone in the treatment of acute PQ poisoning,but more researches will be needed to compare the advantages and disadvantages of them in improving the arterial partial pressure of oxygen.