Aim To investigate therapeutic value and effectiveness evaluation of the continuous renal replacement therapy (CRRT) hemoperfusion combined with continuous veno-venous hemofiltration(HP/CVVH), plasma exchange combined with continuous veno-venous hemofiltration (PE/CVVH) on hyperlipidemic patients with severe acute pancreatitis (HLSAP). Methods 68 patients were randomly divided into CVVH group, HP+CVVH group, PE+CVVH group, herein are SAP and conventional therapy alone CVVH, HP+CVVH, PE+CVVH treatment. The vital signs, APACHE II score, triglyceride (TG),Cü reactive protein (CRP) and important organ function indexes of the three groups were compared before and after treatment for 72 h; The CT severity index (CTSI) change was evaluated by CT examination before and after 1 week of treatment; The incidence of major complications, average length of stay and mortality were recorded within 1 week of treatment. Results There was no significant difference between the three groups before treatment. But all the indexes were improved after treatment in each group(P<0.05). There was no significant difference in APACHE Ⅱ score, serum amylase, and urine amylase between the three groups after treatment for 72 h (P>0.05); Remaining laboratory parameters improved more significantly in HP+CVVH, PE+CVVH groups compared with CVVH group (P<0.05). After 1 week of treatment, the CTSI of three groups decreased compared with before treatment (P<0.05), and the improvement of HP+CVVH group and PE+CVVH group was more obvious than that of CVVH group (P<0.05). Compared with CVVH group, the clinical situation of HP+CVVH group and PE+CVVH group was better, the mortality rate was lower and the length of stay was shorter (P<0.05). Conclusion Compared with CVVH alone, HP, PE combined with CVVH treatment can reduce the serum TG level of patients more quickly, improve clinical symptoms, reduce systemic inflammatory response syndrome (MODS) and multiple organ dysfunction syndrome/multiple organ failure(MOF) occurs, effectively reduce mortality and hospital stay.