Avau Bert, Borra Vere, Vandekerckhove Philippe, De Buck Emmy
Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross-Flanders, Mechelen, Belgium.
Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.
PLoS Negl Trop Dis. 2016 Oct 17;10(10):e0005079. doi: 10.1371/journal.pntd.0005079. eCollection 2016 Oct.
The worldwide burden of snakebite is high, especially in remote regions with lesser accessibility to professional healthcare. Therefore, adequate first aid for snakebite is of the utmost importance. A wide range of different first aid techniques have been described in literature, and are being used in practice. This systematic review aimed to summarize the best available evidence concerning effective and feasible first aid techniques for snakebite.
A systematic literature screening, performed independently by two authors in the Cochrane Library, MEDLINE and Embase resulted in 14 studies, fulfilling our predefined selection criteria, concerning first aid techniques for snakebite management. Data was extracted and the body of evidence was appraised according to the GRADE approach.
The pressure immobilization technique was identified as the only evidence-based first aid technique with effectiveness on venom spread. However, additional studies suggest that proper application of this technique is not feasible for laypeople. Evidence concerning other first aid measures, such as the application of a tourniquet, suggests avoiding the use of these techniques.
The practical recommendation for the treatment of snakebite in a first aid setting is to immobilize the victim, while awaiting the emergency services. However, given the low to very low quality of the data collected, high quality randomized controlled trials concerning the efficacy and feasibility of different variations of the pressure immobilization technique are warranted.
全球蛇咬伤负担沉重，尤其是在难以获得专业医疗服务的偏远地区。因此，对蛇咬伤进行充分的急救至关重要。文献中描述了多种不同的急救技术，并在实践中得到应用。本系统评价旨在总结有关蛇咬伤有效且可行的急救技术的最佳现有证据。
由两名作者独立在Cochrane图书馆、MEDLINE和Embase中进行系统文献筛选，共得到14项符合我们预定义选择标准的关于蛇咬伤处理急救技术的研究。提取数据并根据GRADE方法对证据体进行评估。
压力固定技术被确定为唯一一项对毒液扩散有效的循证急救技术。然而，更多研究表明，外行人难以正确应用该技术。关于其他急救措施（如使用止血带）的证据表明应避免使用这些技术。
在急救环境中治疗蛇咬伤的实际建议是在等待急救服务时固定伤者。然而，鉴于所收集数据的质量低至极低，有必要开展高质量的随机对照试验，以研究压力固定技术不同变体的疗效和可行性。
