血液净化治疗急性百草枯中毒的系统评价

Blood purification in the treatment of acute paraquat intoxication： A system review

[论文特点介绍]血液净化是清除体内中毒物质的一种有效手段，治疗百草枯中毒的疗效存在争议。国内外关于此问题的系统评价还未见发表。本研究旨在用循证医学系统评价的方法，对2006年12月前已发表的用血液净化措施治疗百草枯中毒的随机对照试验和临床对照试验进行评价，为其临床应用提供依据。

Background and objectives Paraquat has h can impair multiple organs especially the lung. There is no specific igh toxicity when ingested orally and antidote for the treatment of paraquat poisoning and the mortality is high. Blood purification is a method to eliminate the toxicants, the effect in the treatment of paraquat poisoning is doubtful,relating system review has not published. The objective of this review is to evaluate the RCTs and CCTs about the effect of blood purification in the treatment of paraquat intoxication. Methods The following databases were searched：CHKD,VIP,MEDLINE,Cochrane library and the reference of gaining articles. The RCTs and CCTs using blood purification to treat paraquat intoxication are selected according to the selection criteria made in advance. The qualities of articles were assessed by the method in evidence- based medicine and meta-analysis was made using the Cochrane system review software RevMan4.2.9. Results 28 articles were included, involving 6 RCTs and 22 CCTs, the quality of them is generally low. The main problems about them are ： the random method is not clear, the diagnostic method is inexact, the description of baseline and the follow-up information are insufficient. The results of 8 meta-analysis comparing mortality or survival time between HP or HP-HD or PE and conventional treatment suggest that various blood purification methods can decrease the death rate and prolong survival time. The mortalities between HP and HP-CVVH have no statistic difference. Conclusions The results of meta-analysis have some bias because of the low quality of included studies. From the results of our meta-analysis and some case report with high quality,we can conclude that ：hemoperfusion or continuous blood purification can prolong the survival time but has no effect on the paraquat poisoning with very large doses. More designed well RCTs are needed to provide more reliable evidence.