• Yahui Wang, Yanqi Wu, Feng Shen, Bo Liu, Hong Qian, Huiling Yang, Yumei Cheng, and Min Liu.
• Guizhou Medical University, Guiyang 550004, Guizhou, China.
• Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Feb 1; 31 (2): 214-220.

ObjectiveTo systematically analyze the effect of haemoperfusion (HP) combined with continuous veno-veno haemofiltration (CVVH) in the treatment of the patients with paraquat poisoning (PQP).MethodsWords 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.ResultsFinally, 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.ConclusionsCombined 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.

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