Abstract
BackgroundAcute severe organophosphorus pesticide poisoning (ASOPP) is a common severe emergency in developing countries. At present, the incidence of complications and mortality are still very high, and there are some difficulties in treatment. More and more studies have found that hemoperfusion combined with hemodialysis can improve the prognosis of patients based on conventional emergency treatment, but there is a lack of evidence-based medical evidence. Our meta-analysis is mainly to clarify the efficacy of hemoperfusion combined with hemodialysis on ASOPP.MethodsWe searched several databases. After formulating relevant inclusion and exclusion criteria, qualified studies were included and data were extracted. The outcome indicators were cure rate, efficacy, incidence of complications, time for cholinesterase level to return to normal, coma time, time of hospitalization and atropine dosage. Results were analyzed using risk ratios (RR), odds ratios (OR), weighted mean difference (WMD), standard mean difference (SMD), and 95% confidential interval (95% CI). The cochrane collaboration tool was used for the assessment of the risk of bias of every included studies. In terms of statistical methods, we used RevMan software (version 5.3) and Stata (version 14 and 16) for data analysis.ResultsWe included 35 RCTs, including 2650 participants. Compared with the emergency conventional treatment group, the use of hemoperfusion combined with hemodialysis to treat ASOPP patients based on conventional emergency treatment significantly increased the cure rate [RR=1.20, 95% CI (1.16, 1.25), p<0.00001], improved the efficacy [OR=2.76, 95% CI (2.07, 3.67), p=0.000], and reduced the incidence of complications [RR=0.26, 95% CI (0.20, 0.34), p<0.00001] and also reduced the patient's time for cholinesterase level to return to normal [WMD=-4.05, 95% CI (-4.40, -3.70), p<0.00001], coma time [SMD=-2.62, 95% CI (-3.08, -2.15), p<0.00001], time of hospitalization [WMD=-5.80, 95% CI (-6.57, -5.02), p<0.00001], and atropine dosage [WMD=-194.81, 95% CI (-223.55, -166.08), p<0.00001].ConclusionHemoperfusion combined with hemodialysis can apparently improve the prognosis of patients and has a good effect in the treatment of acute severe organophosphorus pesticide poisoning. In the future, more scientifically designed large-scale, high-quality, multi-center randomized controlled trials are needed to further illustrate the significance of this study.
Meta-analysis of the efficacy of hemoperfusion combined with hemodialysis in treating acute severe organophosphorus pesticide poisoning
