蛇伤伤口护理专家共识

doi:10.3761/j.issn.0254-1769.2026.19.007

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (19): 2638-2645.DOI: 10.3761/j.issn.0254-1769.2026.19.007

蛇伤伤口护理专家共识

中华护理学会急诊护理专业委员会 (执笔：聂岸柳¹(), 何斌斌², 张树增³, 李剑锋¹, 张建霞⁴, 曾艳⁵, 刘皖娟⁶, 甘秀妮⁷, 黄燕梅⁸, 苏湘芬)¹^,^*()

¹ 广州医科大学附属第一医院急诊科广州市 510163
² 广东省人民医院急诊科广州市 510080
³ 广州医科大学附属第一医院急诊重症监护室广州市 510163
⁴ 北京大学第一医院急诊科北京市 100034
⁵ 海南省人民医院急诊科海口市 570311
⁶ 温州医科大学附属第五医院急诊科丽水市 323000
⁷ 重庆医科大学附属第二医院护理部重庆市 400010
⁸ 中山大学附属第一医院护理部广州市 510080

收稿日期:2026-05-26 出版日期:2026-10-10 发布日期:2026-09-28
*通讯作者: 苏湘芬，E-mail：sxflmp@163.com
作者简介:聂岸柳：男，硕士，主管护师，E-mail：1551970788@qq.com
基金资助:
广州地区临床特色技术项目(2026C-TS020)

Expert consensus on wound care for snakebite

Emergency Nursing Professional Committee of Chinese Nursing Association (Writing Committee：NIE Anliu¹(), HE Binbin², ZHANG Shuzeng³, LI Jianfeng¹, ZHANG Jianxia⁴, ZENG Yan⁵, LIU Wanjuan⁶, GAN Xiuni⁷, HUANG Yanmei⁸, SU Xiangfen)¹^,^*()

¹ Emergency Department， the First Affiliated Hospital of Guangzhou Medical University， Guangzhou 510163， China
² Emergency Department， Guangdong Provincial People’s Hospital， Guangzhou 510080， China
³ Emergency Intensive Care Unit， the First Affiliated Hospital of Guangzhou Medical University， Guangzhou 510163， China
⁴ Emergency Department， Peking University First Hospital， Beijing 100034， China
⁵ Emergency Department， Hainan General Hospital， Haikou 570311， China
⁶ Emergency Department， the Fifth Affiliated Hospital of Wenzhou Medical University， Lishui 323000， China
⁷ Nursing Department， the Second Affiliated Hospital of Chongqing Medical University， Chongqing 400010， China
⁸ Nursing Department， the First Affiliated Hospital，Sun Yat-sen University， Guangzhou 510080， China

Received:2026-05-26 Online:2026-10-10 Published:2026-09-28
* Corresponding author: SU Xiangfen，E-mail：sxflmp@163.com
Funding program:
Guangzhou Regional Clinical Specialty Technology Program(2026C-TS020)

1. ”蛇伤伤口护理专家共识“全文.pdf(1457KB)

摘要/Abstract

摘要：

目的形成蛇伤伤口护理专家共识（以下简称“共识”），以指导护士规范实施蛇伤伤口护理。方法系统检索国内外数据库及相关指南网站，对相关证据进行整合和评价，形成“共识”初稿。分别于2025年12月、2026年2月开展2轮专家函询，于2026年5月进行1轮专家论证会，结合专家意见对“共识”内容进行修订，形成终稿。结果来自国内11个省份的21名专家参与函询，2轮函询的专家积极系数分别为95.5%、100%；专家权威系数为0.893；变异系数分别为0.03~0.21、0~0.13；肯德尔和谐系数分别为0.236、0.374（均P<0.001）。“共识”内容包括7个部分。结论该“共识”具有科学性、严谨性，可为护士对蛇伤伤口实施规范评估和护理提供指导。

关键词: 蛇伤, 伤口, 护理, 专家共识

Abstract:

Objective To formulate an expert consensus on wound care for snakebite（hereinafter referred to as the ‘consensus’），and to guide nurses in standardized implementation of wound care for snakebite. Methods Chinese and international databases as well as relevant guideline websites were systematically searched. The available evidence was summarized and appraised to formulate the initial draft of the ‘consensus’. A total of 2 rounds of Delphi expert consultations（conducted in December 2025 and February 2026） and 1 expert panel discussion（held in May 2026） were conducted to revise the content of the ‘consensus’，resulting in the final draft. Results A total of 21 experts from 11 provinces in China participated in the consultations. The expert response rates for the 2 rounds of Delphi consultations were 95.5% and 100%，respectively. The authority coefficient was 0.893. The coefficients of variation was 0.03~0.21 points and 0~0.13 points correspondingly. The Kendall’s concordance coefficients were 0.236 and 0.374（all P<0.001）. The consensus consists of 7 sections. Conclusion The ‘consensus’ is scientific and rigorous，which can provide standardized guidance for nurses in the assessment and nursing management of snakebite wounds.

Key words: Snakebite, Wound, Nursing Care, Expert Consensus

中华护理学会急诊护理专业委员会 (执笔：聂岸柳, 何斌斌, 张树增, 李剑锋, 张建霞, 曾艳, 刘皖娟, 甘秀妮, 黄燕梅, 苏湘芬). 蛇伤伤口护理专家共识[J]. 中华护理杂志, 2026, 61(19): 2638-2645.

Emergency Nursing Professional Committee of Chinese Nursing Association (Writing Committee：NIE Anliu, HE Binbin, ZHANG Shuzeng, LI Jianfeng, ZHANG Jianxia, ZENG Yan, LIU Wanjuan, GAN Xiuni, HUANG Yanmei, SU Xiangfen). Expert consensus on wound care for snakebite[J]. Chinese Journal of Nursing, 2026, 61(19): 2638-2645.

参考文献 46

[1]	Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings[J]. Lancet, 2023, 401(10385):1382-1398. DOI PMID
[2]	中华医学会急诊医学分会, 国家急诊质控中心, 中国医师协会急诊医师分会, 等. 中国蛇伤救治指南[J]. 中华急诊医学杂志, 2024, 33(7):891-906.
	Emergency Medicine Branch of Chinese Medical Association, National Emergency Medical Quality Control Center, Emergency Physicians Branch of Chinese Medical Doctor Association, et al. Guide to snake wound treatment in China[J]. Chin J Emerg Med, 2024, 33(7):891-906.
[3]	蔡亚林, 杨国盛, 钟涛, 等. 外敷中药治疗蛇咬伤的疗效:随机对照试验网状Meta分析[J]. 创伤外科杂志, 2025, 27(6):420-429.
	Cai YL, Yang GS, Zhong T, et al. Efficacy of external application of traditional Chinese medicine in the treatment of snakebites:a randomized controlled network Meta-analysis[J]. J Trauma Surg, 2025, 27(6):420-429.
[4]	朱元州, 杜宇, 荣霞. 毒蛇致伤临床诊治专家共识[J]. 巴楚医学, 2023, 6(4):1-13.
	Zhu YZ, Du Y, Rong X. Expert consensus on clinical diagnosis and treatment of venomous snake injury[J]. Bachu Med J, 2023, 6(4):1-13.
[5]	T/CACM 1633—2025 毒蛇咬伤中医诊疗指南[S].
	T/CACM 1633—2025 Guidelines for diagnosis and treatment of snake bite in traditional Chinese medicine[S].
[6]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[7]	张媛, 郭锦丽, 刘宏, 等. 慢性伤口患者创面操作性疼痛管理的最佳证据总结[J]. 中华护理杂志, 2024, 59(14):1761-1768.
	Zhang Y, Guo JL, Liu H, et al. The best evidence summary wound procedural pain in patients with chronic management wounds[J]. Chin J Nurs, 2024, 59(14):1761-1768.
[8]	中华护理学会内科专业委员会. 急性缺血性脑卒中静脉溶栓护理指南[J]. 中华护理志, 2023, 58(1):10-15.
	Internal Medicine Nursing Committee of Chinese Nursing As-sociation. Nursing guidelines for intravenous thrombolysis in acute ischemic stroke[J]. Chin J Nurs, 2023, 58(1):10-15. DOI URL
[9]	McGhee S, Finnegan A, Clochesy JM, et al. Effects of snake envenomation:a guide for emergency nurses[J]. Emerg Nurse, 2015, 22(9):24-29.
[10]	Parker-Cote J, Meggs WJ. First aid and pre-hospital management of venomous snakebites[J]. Trop Med Infect Dis, 2018, 3(2):45. DOI URL
[11]	di Nicola MR, Crevani M, Avella I, et al. A guide to the clinical management of Vipera snakebite in Italy[J]. Toxins, 2024, 16(6):255. DOI URL
[12]	Ahmed SM, Ahmed M, Nadeem A, et al. Emergency treatment of a snake bite:pearls from literature[J]. J Emerg Trauma Shock, 2008, 1(2):97-105. DOI URL
[13]	Ubani CB, Sollee DR, Sheikh S. Emergency department management of North American snake envenomations[J]. Emerg Med Pract, 2024, 26(S2):1-44.
[14]	Chen E, Dotters-Katz S, Kuller JA, et al. Venomous snake and spider bites in pregnancy[J]. Obstet Gynecol Surv, 2021, 76(12):760-767. DOI PMID
[15]	Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America?[J]. Clin Toxicol, 2011, 49(5):351-365. DOI URL
[16]	Ralph R, Faiz MA, Sharma SK, et al. Managing snakebite[J]. BMJ, 2022, 376:e057926.
[17]	Jalink MB, Wisse RPL. A guide to direct (peri)ocular injuries caused by snakes:systematic review and treatment advice[J]. Am J Trop Med Hyg, 2022, 107(5):968-973. DOI URL
[18]	di Nicola MR, Pontara A, Kass GEN, et al. Vipers of major clinical relevance in Europe:taxonomy,venom composition,toxicology and clinical management of human bites[J]. Toxicology, 2021, 453:152724. DOI URL
[19]	Evans DD, Nelson LW. Treating venomous snakebites in the United States:a guide for nurse practitioners[J]. Nurse Pract, 2013, 38(7):13-22.
[20]	Mamede CCN, de Sousa Simamoto BB, da Cunha Pereira DF, et al. Edema,hyperalgesia and myonecrosis induced by Brazilian bothropic venoms:overview of the last decade[J]. Toxicon, 2020, 187:10-18 DOI URL
[21]	Newman J, Therriault C, White MS, et al. Compartment syndrome following snake envenomation in the United States:a scoping review of the clinical literature[J]. West J Emerg Med, 2024, 25(4):651-660. DOI PMID
[22]	中华中医药学会外科分会, 王万春, 严张仁. 毒蛇咬伤中医诊疗方案专家共识(2016版)[J]. 中医杂志, 2017, 58(4):357-360.
	Surgery Branch of China Association of Chinese Medicine, Wang WC, Yan ZR. Expert consensus on TCM diagnosis and treatment scheme for snakebite(2016 edition)[J]. J Tradit Chin Med, 2017, 58(4):357-360.
[23]	陈粤明, 苏耿, 陈康杰, 等. 同步脱敏治疗对抗蛇毒血清过敏患者凝血功能的影响[J]. 中国急救复苏与灾害医学杂志, 2022, 17(2):252-255.
	Chen YM, Su G, Chen KJ, et al. Effect of synchronous desensitization therapy on coagulation function in patients with allergic snake venom serum[J]. China J Emerg Resusc Disaster Med, 2022, 17(2):252-255.
[24]	徐爱云, 黎少丽, 刘河群. 注射用抗蛇毒血清分段稀释滴注对蛇咬伤患者的效果观察[J]. 护理实践与研究, 2018, 15(24):155-157.
	Xu AY, Li SL, Liu HQ. Effect of fractional dilution and infusion of anti-venom serum for injection on patients with snake bites[J]. Nurs Pract Res, 2018, 15(24):155-157.
[25]	Rodrigo C, Gnanathasan A. Adjunct treatment in snakebite envenoming:a systematic review of randomised controlled trials[J]. Trans R Soc Trop Med Hyg, 2020, 114(11):847-857. DOI URL
[26]	Rocha GDS, Farias AS, Alcantara JA, et al. Validation of a culturally relevant snakebite envenomation clinical practice guideline in Brazil[J]. Toxins, 2022, 14(6):376. DOI URL
[27]	Russell JJ, Schoenbrunner A, Janis JE. Snake bite management:a scoping review of the literature[J]. Plast Reconstr Surg Glob Open, 2021, 9(4):e3506.
[28]	赖荣德. 蛇伤诊断治疗学[M]. 北京: 科学技术文献出版社, 2025.
	Lai RD. Diagnosis and treatment of snakebite[M]. Beijing: Scientific and Technical Documents Publishing House, 2025.
[29]	周子怡, 王飞霞, 潘喆, 等. 获得性大疱表皮松解症患者创面管理的研究进展[J]. 中华护理杂志, 2023, 58(12):1517-1523. DOI URL
	Zhou ZY, Wang FX, Pan Z, et al. Research progress of wound care in patients with epidermolysis bullosa acquisita[J]. Chin J Nurs, 2023, 58(12):1517-1523. DOI URL
[30]	罗海燕, 刘鸣江, 谢松林, 等. 眼镜蛇咬伤致四肢深层溃疡患者行皮瓣修复的护理[J]. 中华护理杂志, 2019, 54(8):1201-1204. DOI URL
	Luo HY, Liu MJ, Xie SL, et al. Nursing care of patients with deep ulcer of extremities after cobra injury repaired with skin flaps[J]. Chin J Nurs, 2019, 54(8):1201-1204. DOI URL
[31]	Baumgartner KT, Fishburn SJ, Mullins ME. Current management of copperhead snakebites in Missouri[J]. Mo Med, 2019, 116(3):201-205. PMID
[32]	徐军, 孙峰, 王亚, 等. 急诊气道管理共识[J]. 中国急救医学, 2016, 36(6):481-485.
	Xu J, Sun F, Wang Y, et al. Consensus on emergency airway management[J]. Chin J Crit Care Med, 2016, 36(6):481-485.
[33]	Bonilla-Aldana DK, Bonilla-Aldana JL, Ulloque-Badaracco JR, et al. Snakebite-associated infections:a systematic review and meta-analysis[J]. Am J Trop Med Hyg, 2024, 110(5):874-886. DOI URL
[34]	Brenes-Chacon H, Gutiérrez JM, Avila-Aguero ML. Use of antibiotics following snakebite in the era of antimicrobial stewardship[J]. Toxins, 2024, 16(1):37. DOI URL
[35]	Oliveira IS, Pucca MB, Cerni FA, et al. Snakebite envenoming in Brazilian children:clinical aspects,management and outcomes[J]. J Trop Pediatr, 2023, 69(2):fmad010.
[36]	Sachett JAG, da Silva IM, Alves EC, et al. Poor efficacy of preemptive amoxicillin clavulanate for preventing secondary infection from Bothrops snakebites in the Brazilian Amazon:a randomized controlled clinical trial[J]. PLoS Negl Trop Dis, 2017, 11(7):e0005745.
[37]	Gautam A, Indu MB, Bhardwaj A, et al. Clinically directed initiation versus routine use of amoxicillin-clavulanate and the risk of local complications among patients with haemotoxic snakebite envenomation treated at a teaching hospital in southern India:a randomised,non-inferiority trial[J]. BMJ Open, 2025, 15(6):e094409.
[38]	中华医学会骨科学分会外固定与肢体重建学组, 中国医师协会创伤外科医师分会创伤感染专业委员会, 中国医师协会骨科医师分会创伤专家工作委员会. 中国急性骨筋膜室综合征早期诊断与治疗指南(2020版)[J]. 中华创伤骨科杂志, 2020, 22(8):645-654.
	Group of External Fixation and Limb Reconstruction,Society of Orthopaedics, Chinese Medical Association,Trauma Infec-tion Committee of the Traumatic Surgeons Branch,Chinese Medical Doctor Association, Trauma Expert Working Commit-tee of the Orthopedic Branch,Chinese Medical Doctor Asso-ciation. Guidelines on early diagnosis and treatment of acute compartment syndrome in China[J]. Chin J Orthop Trauma, 2020, 22(8):645-654.
[39]	Waiddyanatha S, Silva A, Siribaddana S, et al. Long-term effects of snake envenoming[J]. Toxins, 2019, 11(4):193. DOI URL
[40]	国家卫生健康委办公厅. 常见动物致伤诊疗规范(2021年版)[EB/OL]. (2021-08-06)[2025-08-06]. https://www.nhc.gov.cn/ylyjs/zcwj/202108/2c85b5fa8c844fb7a504fdf0a85d5bd7.shtml.
	General Office of National Health Commission. Diagnostic and treatment specifications for common animal injuries(2021 edition)[EB/OL].(2021-08-06)[2025-08-06]. https://www.nhc.gov.cn/ylyjs/zcwj/202108/2c85b5fa8c844fb7a504fdf0a85d5bd7.shtml.
[41]	苏祖雄, 毛坡, 李江平, 等. 封闭引流技术联合富血小板血浆凝胶在眼镜蛇咬伤溃疡治疗中的应用价值[J]. 中华急诊医学杂志, 2025, 34(8):1126-1128.
	Su ZX, Mao P, Li JP, et al. Application value of closed drainage combined with platelet-rich plasma gel in the treatment of cobra bite ulcer[J]. Chin J Emerg Med, 2025, 34(8):1126-1128.
[42]	中国整形美容协会瘢痕医学分会. 瘢痕早期治疗全国专家共识(2020版)[J]. 中华烧伤杂志, 2021, 37(2):113-125.
	Chinese Association of Plastics and Aesthetics Scar Medicine Branch. National expert consensus on early management of scars(2020 version)[J]. Chin J Burns, 2021, 37(2):113-125.
[43]	Chen Y, Fu WN, Song XY, et al. The bridge relationships of PTSD and depression symptoms among snakebite victims:a cross-sectional community-based survey[J]. BMC Psychol, 2024, 12(1):470. DOI PMID
[44]	Bhaumik S, Kallakuri S, Kaur A, et al. Mental health conditions after snakebite:a scoping review[J]. BMJ Glob Health, 2020, 5(11):e004131.
[45]	苏湘芬, 刘荣, 关文洁, 等. 全程健康教育在毒蛇咬伤患者中的应用[J]. 广东医学, 2017, 38(10):1622-1624.
	Su XF, Liu R, Guan WJ, et al. Application of whole-course health education in patients bitten by poisonous snakes[J]. Guangdong Med J, 2017, 38(10):1622-1624.
[46]	应航宇, 杨敏, 袁丞达, 等. 基于网状Meta分析的中西医结合治疗五步蛇咬伤的效果评价[J]. 广州中医药大学学报, 2023, 40(8):2117-2123.
	Ying HY, Yang M, Yuan CD, et al. Effectiveness evaluation of integrated Chinese and western medicine therapy for snakebite of deinagkistrodon acutus:a network meta-analysis[J]. J Guang-zhou Univ Tradit Chin Med, 2023, 40(8):2117-2123.

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Expert consensus on wound care for snakebite

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