Clinical effect of haemoperfusion combined with continuous veno-veno haemofiltration in treatment of paraquat poisoning: a Meta-analysis / 中华危重病急救医学

ABSTRACT

Objective? To?systematically?analyze?the?effect?of?haemoperfusion?(HP)?combined?with?continuous?veno-veno?haemofiltration?(CVVH)?in?the?treatment?of?the?patients?with?paraquat?poisoning?(PQP).? Methods? Words?of?paraquat,?poisoning,?continuous?venous?hemofiltration,?hemoperfusion,?hemodiafiltration?in?Chinese?and?paraquat,?poisoning,?intoxication,?haemofiltration,?continuous?venovenous?haemofiltration,?haemoperfusion?in?English?were?chosen?as?keywords,?the?Chinese?and?English?literatures?about?acute?PQP?treated?with?HP?combined?with?CVVH?published?in?Wanfang?database,?CNKI,?CBM,?VIP?database,?PubMed,?Embase,?Cochrane?Library?were?searched?by?computer,?and?the?retrieval?time?was?from?the?establishment?of?the?database?to?July?2018.?The?experimental?group?was?treated?with?HP?combined?with?CVVH,?while?the?control?group?was?treated?with?HP?alone.?Besides,?the?outcome?indicators?included?mortality,?survival?time?of?dead?patients?(the?patient's?time?from?exposure?to?poison?to?death),?serum?creatinine?(SCr),?alanine?aminotransferase?(ALT),?arterial?partial?pressure?of?oxygen?(PaO2),?and?incidence?of?circulatory?and?respiratory?failure.?The?literature?data?were?extracted?by?two?researchers?independently,?the?quality?of?the?literature?was?evaluated? according?to?the?modified?Jadad?score?table?or?Newcastle-Ottawa?scale?(NOS),?and?the?Meta-analysis?was?carried?out?by?RevMan?5.3?software;?and?the?stability?of?the?results?of?Meta-analysis?was?tested?by?sensitivity?analysis.?Further,?the?publication?bias?was?analyzed?through?drawing?a?funnel?diagram.? Results? Finally,?20?articles?were?included,?with?18?in??Chinese?and?2?in?English.?Among?them,?6?were?randomized?controlled?trial?(RCT)?and?14?were?case-control?studies.?Furthermore,?a?total?of?2?870?patients?were?involved,?with?1?558?in?the?control?group?and?1?312?in?the?experimental?group.?Meta-analysis?showed?that?the?mortality?rate?of?patients?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?[odds?ratio?(OR)?=?0.55,?95%?confidence?interval?(95%CI)?=?0.42?to?0.73,?P <?0.000?1],?the?patients'?time?from?toxin?exposure?to?death?was?significantly?longer?than?that?in?the?control?group?[standard?mean?difference?(SMD)?=?2.16,?95%CI?=?1.46?to?2.86,?P?<?0.000?01).?In?the?course?of?treatment,?the?peak?value?of?SCr?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?(SMD?=?-0.53,?95%CI?=?-0.65?to?-0.42,?P?<?0.000?01),?and?the?peak?value?of?ALT?was?also?decreased?(SMD =?-0.72,?95%CI?=?-0.99?to?-0.44,?P?<?0.000?01).?Besides,?there?was?no?significant?difference?in?PaO2?between?the?two?groups?on?the?3rd?day?of?treatment?(SMD =?0.15,?95%CI?=?-0.19-0.49,??P?=?0.40),?but?on?the?7th?day,?PaO2?in?the?experimental?group?was?significantly?higher?than?that?in?the?control?group?(SMD?=??0.23,?95%CI =?0.29?to?0.98,?P?=?0.000?3).?Furthermore,?the?incidence?of?circulatory?failure?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?(OR =?0.26,?95%CI?=?0.19?to?0.37,?P?<?0.000?01),?but?the?incidence?of?respiratory?failure?was?significantly?higher?than?that?in?the?control?group?(OR =?4.14,?95%CI?=?3.00?to?5.72,?P?<?0.000?01).?The?influence?of?heterogeneity?on?statistical?results?was?excluded?in?the?sensitivity?analysis,?and?funnel?plot?diagram?was?applied?to?indicate?the?publication?bias?of?mortality?and?survival?time?of?the?dead?patients.? Conclusion? Combined?with?HP?alone,?HP?combined?with?CVVH?could?better?improve?liver?and?kidney?function?and?oxygenation?state?of?PQP?patients,??reduce?the?incidence?of?early?circulatory?failure,?prolong?the?survival?time?and?reduce?the?death?rate?of?PQP?patients.