Page 1


¤³Ð·Õ»è ÃÖ¡ÉÒÇÒÃÊÒà À¡.ÇÔÊØ·¸Ôì ÊØÃÔÂÒÀÔÇѲ¹ À¡.¤·Ò ºÑ³±ÔµÒ¹Ø¡ÙÅ À¡.ªÙÈÑ¡´Ôì äÁµÃÕÁԵà À­.¼È.ÍÀÔÄ´Õ àËÁÐ¨Ø±Ò À¡.»ÃÐÇԷ µÑ¹µÔÊØÇԷ¡ØÅ À¡.¼È.´Ã.ºØÃÔ¹·Ã µ.ÈÃÕǧɏ ¼È.´Ã.À­.Ã؋§à¾çªÃ Ê¡ØźíÒÃاÈÔÅ»Š ÃÈ.´Ã.ÇÔÇÃø¹ ÍѤÃÇÔàªÕÂà ¡ÃÃÁ¡ÒúÃÔËÒÃÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹ (»ÃÐà·Èä·Â) ¹Ò¡ÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹ (»ÃÐà·Èä·Â) À¡.¸ÕÃÇØ²Ô ¾§ÈàÈÃÉ°ä¾ÈÒÅ ÍØ»¹Ò¡ À­.»ÃÐä¾ÈÃÕ ÈÒ¹µÔǧɏ¡Òà À­.ÁÑ·ÂÒ ¾Ñ¹¸Ø¡Ò¹¹· àÅ¢Ò¸Ô¡ÒÃÊÁÒ¤ÁÏ À­.ªŒÍ§ÁÒÈ ¹ÔµÈÔ Ä§¤ÒÃÔ¹ àËÃÑ­­Ô¡ À­.¹ÀҾà àʶÕÂøÃÃÁ¡ØÅ ½†ÒÂËÒÃÒÂ䴌 À­.¨ÔÃÇÃó â;ÃÊÇÑÊ´Ôì ÇÔªÒ¡Òà áÅÐ ÊÒÃÒ³Õ¡à À­.¹ÔµÂÒÇÃó ¡ØųÒÇÃó ¾Ñ²¹Òº·ºÒ·ÃŒÒ¹ÂÒ À­.ÊØ³Õ »˜­­ÒÇزÔä¡Ã À¡.ÊØ·¸ÔÈÑ¡´Ôì Ãѵ¹ºØÃÕ Ê×Íè ÊÒÃͧ¤¡Ã À­.³Õùت ·ÃѾ·ÇÕ À¡.»ÃÐÇԷ µÑ¹µÔÊØÇԷ¡ØÅ ÊÁÒªÔ¡ÊÑÁ¾Ñ¹¸ À¡.à¸ÕÂà ¨ÔÃÇÃҾѹ¸ ¾Ñ²¹ÒÁҵðҹÌҹÂÒ À¡.ÊÁºÑµÔ ᡌǨԹ´Ò À­.ÈÔÃÔÃѵ¹ µÑ¹»ªÒµÔ À¡.ªÒ­ªÑ ÈÃÕÁ§¤Å»·ØÁ Œ ÁÔ ¾à¼Âá¾Ã‹ ਌Ңͧ¼Ù¾ ÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹ (»ÃÐà·Èä·Â) ÍÒ¤ÒÃàÀÊѪ¡ÃÃÁÊÁÒ¤Ááˋ§»ÃÐà·Èä·Â (À.Ê.·.) 40 «ÍÂÊѹµÔÊØ¢ (ÊØ¢ØÁÇÔ· 38) ¶.ÊØ¢ØÁÇÔ· á¢Ç§¤ÅͧàµÂ ࢵ¤ÅͧàµÂ ¡ÃØ§à·¾Ï 10110 â·Ã. 0 2713 5261-63 â·ÃÊÒà 0 2713 5541 ½†Ò»ÃÐÊÒ¹§Ò¹ ¹.Ê.¡ÄÉ­Ò ·Í§à·È ¹.Ê.ÊØÇÃÃ³Õ àÊÃÔÁÊÔ¹ªÑÂÊ¡ØÅ ¨Ñ´¾ÔÁ¾Šâ´Â ºÃÔÉÑ· ·Õ ¤ÔÇ ¾Õ àÅ¢·Õè 163 «Í¾Öè§ÁÕ 11 á¢Ç§ºÒ§¨Ò¡ ࢵ¾ÃÐ⢹§ ¡ÃØ§à·¾Ï 10260 â·Ã. 0 2682 3888, 08 5088 3079 â·ÃÊÒÃ. 0 2932 5644

»‚·Õè 8 ©ºÑº·Õè 46 à´×͹µØÅÒ¤Á 2552 Website : www.pharcpa.com, E-mail : cpa_thailand@yahoo.com

ÊÒúѭ º·ºÃóҸԡÒà ¤Ø¡Ѻ¹Ò¡ º·¤ÇÒÁ¾ÔàÈÉ º·¤ÇÒÁ¾ÔàÈÉ

º·¤ÇÒÁ¾ÔàÈÉ º·¤ÇÒÁ¾ÔàÈÉ

º·¤ÇÒÁ¾ÔàÈÉ âäáÅСÒÃÃÑ¡ÉÒ ÂÒáÅСÒÃ㪌ÂÒ ¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾ ¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾ º·¤ÇÒÁ CPE Ẻ·´Êͺ¤ÇÒÁÃٌ ẺµÍº¤íÒ¶ÒÁ ãºÊÁѤÃÊÁÒªÔ¡ ¢‹ÒÇ»ÃЪÒÊÑÁ¾Ñ¹¸

“¨ÃÔ¸ÃÃÁ” ¤×ͤس¸ÃÃÁ¢Í§¼ÙŒ»ÃСͺ¸ØáԨ »˜¨¨Ñ·ÕèÁռŵ‹Í¡ÒÃࢌÒËÇÁ â¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ Factors Affecting the Pharmacy Owner to Participate in Community Pharmacy Development and Accreditation Program ¨Ñº¡ÃÐáÊ¡ÒþѲ¹ÒÌҹÂÒ “ÂÒ¡Å؋Á¾ÔàÈÉÊíÒËÃѺÌҹÂҤسÀÒ¾” “¤Ù‹Á×;Ѳ¹Òµ¹àͧÊً GPP” ໚¹à¤Ã×èͧÁ×ͪ‹Ç¾Ѳ¹Ò áÅСÃдѺ ¤Ø³ÀÒ¾ÁҵðҹàÀÊѪ¡ÃÃÁªØÁª¹ à¡Ãç´¹‹ÒÃٌ¨Ò¡ ÍÂ. 䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 A (H1N1) »¯Ô¡ÔÃÔÂÒÃÐËNjҧÂҡѺÊÁعä¾Ã ÊÁعä¾Ã¹‹ÒÃٌ à¨ÕÂǡٌËÅÒ¹ (Jiaogulan) Nutrition for Oral and Dental Health âÀª¹Ò¡ÒÃÊíÒËÃѺª‹Í§»Ò¡áÅп˜¹ ÂÒµŒÒ¹äÇÃÑÊÊíÒËÃѺ䢌ËÇÑ´ãË­‹

º·¤ÇÒÁµ‹Ò§æ ·ÕèµÕ¾ÔÁ¾ã¹ÇÒÃÊÒéºÑº¹Õé ¶×Í໚¹ÅÔ¢ÊÔ·¸Ôì¢Í§ÇÒÃÊÒÃÏ áÅмٌà¢Õ¹ ˌÒÁ¹íÒä»à¼Âá¾Ã‹â´ÂäÁ‹ä´ŒÃѺ͹حҵ

6 7 8

12 19

20 29 34 35 39 45 48 52 53 55 56


º·ºÃóҸԡÒÃ

ÊÇÑÊ´Õ¤‹ÐÊÁÒªÔ¡·Ø¡æ ·‹Ò¹ ÇÒÃÊÒéºÑº¹Õ麷¤ÇÒÁÇÔªÒ¡ÒÃ์¹¤ÇÒÁÊíҤѭ¢Í§âä䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 «Ö觡íÒÅѧǡ¡ÅѺÁÒÍÕ¡ÃÐÅ͡˹Öè§ã¹ª‹Ç§»ÅÒ»‚ àÀÊѪ¡ÃªØÁª¹·Ø¡·‹Ò¹¤ÇÃÁÕʋǹËÇÁ㹡Òû‡Í§¡Ñ¹ ªØÁª¹¢Í§·‹Ò¹ãˌ»ÅÍ´ÀѨҡâä¹Õé ¡ÒÃãˌ¤ÇÒÁÃٌ¡Òû‡Í§¡Ñ¹µ¹àͧ¨Ò¡âä ¡ÒÃࢌÒ㨡Ãкǹ¡Òà ÃÑ¡ÉÒáÅл‡Í§¡Ñ¹¡ÒÃá¾Ã‹¡ÃШÒÂâäàÁ×è͵Դàª×éÍ ÊÔè§àËŋҹÕé¤ÇÃ䴌ÃѺ¡Òú͡¡Å‹ÒǨҡàÀÊѪ¡ÃªØÁª¹ àÁ×èÍÁռٌÁÒÃѺºÃÔ¡Òèҡ·‹Ò¹ ¹Í¡¨Ò¡º·¤ÇÒÁÇÔªÒ¡ÒÃà¡ÕèÂǡѺ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ·‹Ò¹ÂѧÊÒÁÒö·´Êͺ¤ÇÒÁÃٌàÃ×èͧâäáÅÐÂÒ·Õè㪌ÃÑ¡ÉÒ䴌¨Ò¡º·¤ÇÒÁ¡ÒÃÈÖ¡ÉÒµ‹Íà¹×èͧ ÊíÒËÃѺº·¤ÇÒÁ¾ÔàÈÉ©ºÑº¹Õé䴌¹íÒàʹͺ·¤ÇÒÁ·Õèà¡ÕèÂÇ¢ŒÍ§¡Ñº¡ÒþѲ¹ÒÌҹÂҤسÀÒ¾ â´ÂÇÔà¤ÃÒÐˏ¶§Ö »˜­ËÒáÅÐÍØ»ÊÃä ¤ÇÒÁ¡ŒÒÇ˹ŒÒ¡ÒÃËҧËÅÑ¡¡Ò÷մè ãÕ ¹¡Òû¯ÔºµÑ §Ô Ò¹àÀÊѪ¡ÃÃÁªØÁª¹ (Good Pharmacy Practice of Community Pharmacy) à¾×Íè 㪌໚¹á¹Ç·Ò§¡ÒþѲ¹Ò¤Ø³ÀÒ¾¡ÒúÃÔ¡Òà áÅÐ໚¹à¡ÃÒл‡Í§¡Ñ¹µÑÇàÁ×Íè àÃÒ»¯ÔºµÑ µÔ ÒÁá¹Ç·Ò§Ï áŌǼÙÌ ºÑ ºÃÔ¡ÒÃäÁ‹¾Í㨠¹Í¡¨Ò¡¹ÕÂé §Ñ ÁÕà¡Ãç´¤ÇÒÁÃٌ ¨Ò¡ ÍÂ. áÅШÃÔ¸ÃÃÁ¢Í§àÀÊѪ¡ÃªØÁ¹ ÇѹàÇÅÒ¼‹Ò¹ä»ÃÇ´àÃçÇÁÒ¡ ÍÕ¡äÁ‹¡Õèà´×͹¨ÐËÁ´»‚ 2552 àÃÒÁÕ¡Ô¨¡ÃÃÁ¹Ñ´ËÁÒ¡ѺÊÁÒªÔ¡ ËÅѧ»‚ãËÁ‹¤×Í ¡ÒûÃЪØÁãË­‹ÊÒÁÑ­»ÃШíÒ»‚ ¨Ö§¢Íú¡Ç¹ÊÁÒªÔ¡·Ø¡·‹Ò¹ª‹ÇÂÅçÍ¡µÒÃÒ§¹Ñ´ËÁÒ änjŋǧ˹ŒÒ ÊÇÑÊ´Õ¤‹Ð À­.¹Ô µ ÂÒÇÃó ¡Ø Å ³ÒÇÃó ºÃóҸԡÒÃ

6


¤Ø¡Ѻ¹Ò¡ ÊÇÑÊ´Õ¤ÃѺà¾×Íè ¹ÊÁÒªÔ¡·ÕÃè ¡Ñ ·Ø¡·‹Ò¹ ¹Õ¡è ãç ¡ÅŒ¨ÐËÁ´ä»ÍÕ¡Ë¹Ö§è »‚áÅŒÇ à»š¹Í‹ҧäúŒÒ§ ÊíÒËÃѺ»‚·¼Õè ҋ ¹Áҡ礧àËç¹æ ¡Ñ¹Ç‹Ò໚¹»‚·àÕè ¨çº»Ç´¡Ñ¹ÁÒ¡·Ñ§é âš㺹ըé Ò¡ÀÒÇÐàÈÃÉ°¡Ô¨áÅÐ ¡ÒÃàÁ×ͧÊíҷѺ´ŒÇÂâäÀÑÂ䢌à¨çº·Õè´Ù¨Ð໚¹¡ÃÐáÊâÅ¡áÅТͧ»ÃÐà·ÈÍÂًËÅÒÂà´×͹ áÅдÙàËÁ×͹ÂѧäÁ‹ÊÔé¹ÊØ´àÊÕ·Õà´ÕÂÇã¹¢³Ð¹Õé äÁ‹à»š¹ääÃѺª‹Ç§¹Õ餧µŒÍ§¤Ô´ºÇ¡¡Ñ¹ÁÒ¡æ áÅÐÍÒ¨µŒÍ§¹ŒÍÁàÍÒ¸ÃÃÁзվè ÃÐÈÒÊ´Ò¾Ãоط¸à¨ŒÒänj໚¹ÍÒÇظÊíҤѭ㹡ÒûÃСͺÇÔªÒªÕ¾ ¤Ô´´Õ ·íÒ´Õ ¡ç¨ÐÁÕᵋÊÔ觴Õæ ÁÒËÒàÃÒàͧ¤ÃѺ ¡ÒÃãˌ¤ÇÒÁª‹ÇÂàËÅ×Íà¾×è͹Á¹Øɏ㹰ҹР·Õàè ÃÒ໚¹¼Ù·Œ »èÕ ÃСͺÇÔªÒªÕ¾·Õàè ¡ÕÂè ǡѺâäÀÑÂ䢌à¨çº¹Ñºà»š¹ÇÒʹҢͧàÃÒ·Õäè Á‹µÍŒ §ä»»ÃСͺ ÍÒªÕ¾Í×¹è ઋ¹ ÌҹÍÒËÒ÷ÕÍè Ò¨µŒÍ§¦‹ÒÊѵǏµ´Ñ ªÕÇµÔ ·íÒãˌµÍŒ §¼Ô´ÈÕŻҳҵԻҵÒÊÌҧ¡ÃÃÁ ¡Ñ¹äÁ‹Ãٌ¨Ñ¡ÊÔé¹ÊØ´ ¢Í¾Ù´¶Ö§ÇÔªÒªÕ¾¢Í§àÃҡѹÍÕ¡Êѡ˹‹Í¤ÃѺ ¾Ç¡àÃÒ·Õè໚¹àÀÊѪªØÁª¹ÊÁѹÕ餧 µŒÍ§à»ÅÕè¹á»Å§ÇÔ¸Õ¡Ò÷íÒ§Ò¹¡Ñ¹â´Â㪌ËÅÑ¡¡Òâͧ¡ÒúÃÔºÒÅàÀÊѪ¡ÃÃÁÁÒ¡¢Öé¹à¾ÃÒÐ ÇÔ ª ÒªÕ ¾ àÀÊÑ ª ªØ Á ª¹ã¹»ÃÐà·ÈªÑé ¹ ¹í Ò ã¹»˜ ¨ ¨Ø ºÑ ¹ ¡ç ËÑ ¹ ÁÒ·Ò§¹Õé ¡Ñ ¹ ËÁ´áŌ Ç µÒÁ·Õè à ¤Â àŋÒàÃ×Íè §·Õäè »»ÃЪØÁ·ÕÊè §Ô ¤â»ÃÁÒãˌ¿§˜ 㹩ºÑº¡‹Í¹à¾ÃÒйաè àç »š¹¡ÃÐáÊâÅ¡¤ÃѺ àÃÒ¨Ö§¨íÒµŒÍ§ à¡ÒСÃÐáʹÕ鴌ÇÂàËÁ×͹¡Ñ¹à¾ÃÒмŷÕè䴌ÁÕÊͧ»ÃСÒä×Í ·íÒãˌàÃÒÍÂًÃʹ㹡ÃÐáÊ¡Òà ᢋ § ¢Ñ ¹ ´Œ Ò ¹ÃÒ¤Ò áÅзí Ò ãˌ Ì Ò ¹àÃÒ໚ ¹ Ì Ò ¹·Õè Í Âً 㠹㨢ͧÅÙ ¡ ¤Œ Ò ËÃ× Í ¼ÙŒ ã ªŒ º ÃÔ ¡ ÒÃ䴌 ËÅÑ¡¡Òâͧ¡ÒúÃÔºÒÅàÀÊѪ¡ÃÃÁËÁÒ¶֧ ¡Ãкǹ¡Ò÷Õè¼ÙŒ»ÃСͺÇÔªÒªÕ¾àÀÊѪ¡ÃÃÁ ¡ÃзíÒµ‹Í¼ÙŒ»†Ç ËÃ×ÍËÇÁ¡ÑºÇÔªÒªÕ¾·Ò§ÊÒ¸ÒóÊØ¢Í×è¹ã¹¡Ò䌹ËÒ »‡Í§¡Ñ¹ ᡌ䢻˜­ËÒ ·Õèà¡ÕèÂÇà¹×èͧ¡Ñº¡ÒÃ㪌ÂÒ ÃÇÁ¶Ö§¡ÒõԴµÒÁá¼¹¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒ·Ñ駷ҧµÃ§áÅзҧ͌ÍÁ ã¹á§‹»ÃÐÊÔ·¸ÔÀÒ¾áÅФÇÒÁ»ÅÍ´ÀÑ 㹡ÒÃ㪌ÂÒ µÅÍ´¨¹¤ÇÒÁËÇÁÁ×Í㹡ÒÃ㪌ÂҢͧ¼Ù»Œ dž  à¾×èÍãˌ䴌¼ÅÊÑÁÄ·¸Ôì·Õè´Õ¢Í§¡ÒúíҺѴÃÑ¡ÉÒ´ŒÇÂÂÒµÒÁ¤ÇÒÁµŒÍ§¡Ò÷Õè᷌¨ÃÔ§¢Í§¼ÙŒ»†Ç à¾×Íè ¤Ø³ÀÒ¾ªÕÇµÔ ·Õ´è Õ â´Âãˌ¡ÒúÃÔ¡ÒÃàÀÊѪ¡ÃÃÁẺºÙóҡÒü‹Ò¹¡Ô¨¡ÃÃÁµ‹Ò§æ ·Ñ§é ´ŒÇ¡Òà µÔ´µÒÁ»˜­ËÒ·Õèà¡ÕèÂÇà¹×èͧ¡Ñº¡ÒÃ㪌ÂÒ ¡ÒûÃÐàÁÔ¹¡ÒÃ㪌ÂÒ ¡ÒÃãˌ¤íÒ»ÃÖ¡ÉÒ´ŒÒ¹ÂÒ ¡ÒõÃǨµÔ´µÒÁÍÒ¡ÒÃäÁ‹¾§Ö »ÃÐʧ¤¨Ò¡¡ÒÃ㪌ÂÒ ¡ÒúÃÔºÒżٻŒ dž ·Õãè ªŒÂÒ·Õºè Ҍ ¹ ¡ÒÃãˌÊÒÃÐ ¤ÇÒÁÃÙàŒ Ã×Íè §ÂÒ áÅÐËÁÒÂÃÇÁ¶Ö§¡Ò䌹ËÒ »‡Í§¡Ñ¹ ᡌ䢻˜­ËÒ·Õàè ¡ÕÂè Çà¹×Íè §¨Ò¡ÂÒã¹ÃдѺªØÁª¹ ¡ÃÐáÊâÅ¡·Ø¡Çѹ¹Õàé ¢ŒÒÁÒÂا‹ à¡ÕÂè ǡѺ¡ÒûÃСͺÍÒªÕ¾¢Í§¾Ç¡àÃÒÁÒ¡¢Ö¹é æ ·Ø¡·Õ¤ÃѺ ¡ÒûÃÑ º µÑ Ç à¾×è Í ¡ÒÃÍÂً à ʹ¨Ö § ໚ ¹ ÊÔè § Êí Ò ¤Ñ ­ ·Õè ·Ø ¡ ¤¹¾Ö § ¤í Ò ¹Ö § ¶Ö § àµÃÕ Â ÁµÑ Ç ãˌ ¾ Ì Í Á¡Ñ ¹ ´Õ¡Ç‹Ò¹Ð¤ÃѺ ´ŒÇ¤ÇÒÁ»ÃÒö¹Ò´Õ À¡.¸Õ à ÇØ ²Ô ¾§È à ÈÃÉ°ä¾ÈÒÅ ¹Ò¡ÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹ (»ÃÐà·Èä·Â)

7


À¡.ÇÔÊ·Ø ¸Ôì ÊØÃÂÔ ÒÀÔDz Ñ ¹

º·¤ÇÒÁ¾ÔàÈÉ

ã¹ÇѲ¹¸ÃÃÁµÐÇѹÍÍ¡·ÕèàËç¹ä´ŒªÑ´Í‹ҧ»ÃÐà·È¨Õ¹ »ÃÐà·È­Õè»Ø‹¹ ¡ÒõԴµ‹Í¡Ñ¹·Ò§¸ØáԨáÅСÒûÃСͺ ¡Ô¨¡Òèеѧé Áѹè ÍÂÙº‹ ¹ “ÊѨ¨Ð” ¤ÇÒÁàª×Íè ¶×ÍÃÐËNjҧ¡Ñ¹ (Trust and Confidence) «Ö§è µ‹Ò§¨Ò¡ÇѲ¹¸ÃÃÁµÐÇѹµ¡·Õ¡è ÒõԴµ‹Í ·Ò§¸ØáԨËÃ×Í¡ÒûÃСͺ¡Ô¨¡ÒèÐ໚¹ä»ã¹Åѡɳзյè ͌ §ãªŒ “ÊÑ­­Ò” ŧÅÒÂÁ×ͪ×Íè ½†Ò·Õàè ¡ÕÂè Ç¢ŒÍ§ (Written Evidence) µ‹ÍÁÒàÁ×èÍÇѲ¹¸ÃÃÁµÐÇѹµ¡à¼ÂἋࢌÒÁÒÊًµÐÇѹÍÍ¡ã¹ÅѡɳТͧ¡ÒÃŋÒàÁ×ͧ¢Öé¹ »ÃСͺ¡Ñº¤ÇÒÁà¨ÃÔ­¡ŒÒÇ˹ŒÒ ¢Í§ÇÔ·ÂÒÈÒʵϴҌ ¹à·¤â¹âÅÂÕ Ãкº¢Í§¡®ËÁÒÂᾋ§áÅоҳԪ¨§Ö ¶Ù¡ºÑ­­ÑµãÔ ªŒã¹âÅ¡µÐÇѹÍÍ¡´ŒÇÂઋ¹¡Ñ¹ ¡ÒäØÁŒ ¤Ãͧ ÊÔ·¸Ô¢Í§¼Ù»Œ ÃСͺ¸ØáԨ´ŒÇ¡ѹàͧ ¡ÒäØÁŒ ¤ÃͧÊÔ·¸Ô¢Í§¼ÙºŒ ÃÔâÀ¤¨Ö§ä´Œº­ Ñ ­ÑµäÔ ÇŒà»š¹¡®ËÁÒ ÊÔ§è ÊíÒ¤Ñ­Ë¹Ö§è ·Õäè ´Œº­ Ñ ­ÑµäÔ ÇŒ 㹡®ËÁÒÂᾋ§¤×ÍàÃ×Íè §¢Í§¤ÇÒÁÊبÃÔµ¢Í§ºØ¤¤Åã¹Êѧ¤Á (·Ñ§é ¼Ù»Œ ÃСͺ¸ØáԨáÅмٺŒ ÃÔâÀ¤) 㹡®ËÁÒÂä·Â ¡®ËÁÒ ·Õè¤ØŒÁ¤Ãͧ¼ÙŒ»ÃСͺ¸ØáԨ·ÕèàËç¹ä´ŒªÑ´¤×Í¡®ËÁÒ´ŒÒ¹·ÃѾÊÔ¹·Ò§»˜­­Ò Í‹ҧઋ¹ ¡®ËÁÒ ÊÔ·¸ÔºµÑ à ¡®ËÁÒÂÅÔ¢ÊÔ·¸Ôì ¡®ËÁÒÂà¤Ã×Íè §ËÁÒ¡ÒäŒÒ ¡®ËÁÒ¤ÇÒÁÅѺ·Ò§¡ÒäŒÒ ໚¹µŒ¹ ʋǹ¡®ËÁÒ¤ØÁŒ ¤Ãͧ¼ÙºŒ ÃÔâÀ¤¹Ñ¹é ÁÕ¨Òí ¹Ç¹ÁÒ¡ ઋ¹ ¡®ËÁÒ¤ØÁŒ ¤Ãͧ¼ÙºŒ ÃÔâÀ¤ ¡®ËÁÒ à¡ÕèÂǡѺÍÒËÒÃáÅÐÂÒ ¡®ËÁÒÂà¤Ã×èͧÊíÒÍÒ§ ໚¹µŒ¹ ¡®ËÁÒ¤،Á¤Ãͧ¼ÙŒºÃÔâÀ¤ ·Õè ºÑ ­ ­Ñ µÔ ä nj ªÑ ´ ᨌ § à¡Õè Â Ç¡Ñ º ¤ÇÒÁÊØ ¨ ÃÔ µ ¢Í§¼ÙŒ » ÃСͺ¸Ø à ¡Ô ¨ ¤× Í ¾ÃÐÃÒªºÑ ­ ­Ñ µÔ ÇÔ¸Õ¾Ô¨ÒóҤ´Õ¼ÙŒºÃÔâÀ¤ ¾.È.2551 «Öè§ÁÕ¤ÇÒÁÊíҤѭµ‹Í¤ÇÒÁÃѺ¼Ô´¢Í§à¨ŒÒ¢Í§ ÊÔ¹¤ŒÒáÅмٌ»ÃСͺÇÔªÒªÕ¾

·Ø¡¤¹µŒÍ§ãªŒÊÔ·¸Ôâ´ÂÊبÃÔµ

µÒÁ»ÃÐÁÇÅ¡®ËÁÒÂᾋ§áÅоҳԪº­ Ñ ­ÑµäÔ ÇŒÇҋ 㹡ÒÃãªŒÊ·Ô ¸ÔËÃ×Í ã¹¡ÒêíÒÃÐ˹Õé ºØ¤¤Å·Ø¡¤¹µŒÍ§¡ÃзíÒâ´ÂÊبÃÔµ (Á.5) ãˌµ¤Õ ÇÒÁÊÑ­­Ò໚¹ 仵ÒÁ¤ÇÒÁ»ÃÐʧ¤ã¹·Ò§ÊبÃÔµâ´Â¾Ôà¤ÃÒÐˏ¶§Ö »¡µÔ»ÃÐླմnj  (Á.368) â´ÂÃкØNjҺؤ¤Å·Ø¡¤¹·Õè»ÃÐʧ¤¨Ð㪌ÊÔ·¸Ô·Ò§ÈÒÅ (㪌ÊÔ·¸ÔµÒÁ¡®ËÁÒÂ) ¨ÐµŒÍ§µÑ§é Áѹè ÍÂÙ㋠¹à¨µ¹Ò·Õºè ÃÔÊ·Ø ¸Ôì (Act of good faith) ¡‹Í¹ ¨Ö§¨Ðä´ŒÃºÑ ¤ÇÒÁ ¤ØÁŒ ¤ÃͧÊÔ·¸ÔµÒÁ¡®ËÁÒ ´ŒÇÂËÅÑ¡¡ÒÃÍѹà´ÕÂǡѹ¹Õàé ͧ ã¹¾ÃÐÃÒªºÑ­­ÑµÇÔ ¸Ô Õ ¾Ô¨ÒóҤ´Õ¼ÙŒºÃÔâÀ¤ ¾.È.2551 «Öè§à»š¹¡®ËÁÒÂÁ؋§à¹Œ¹¤ØŒÁ¤Ãͧ¼ÙŒºÃÔâÀ¤ ´ŒÒ¹¡ÒÃ䴌ÃѺ¡Òê´ãªŒ¤‹ÒàÊÕÂËÒÂÍѹ໚¹¸ÃÃÁ ¨Ö§ä´ŒºÑ­­ÑµÔ໚¹ÁÒµÃÒ Êí Ò ¤Ñ ­ ˹Öè § änj Nj Ò “㹡ÒÃ㪌 ÊÔ · ¸Ô á ˋ § µ¹¡ç ´Õ ã ¹¡Òêí Ò ÃÐ˹Õé ¡ç ´Õ ¼ÙŒ » ÃСͺ ¸ØáԨµŒÍ§¡ÃзíÒ´ŒÇ¤ÇÒÁÊبÃÔµâ´Â¤íÒ¹Ö§¶Ö§Áҵðҹ·Ò§¡ÒäŒÒ·ÕèàËÁÒÐÊÁ ÀÒÂ㵌 à кº¸Ø à ¡Ô ¨ ·Õè à »š ¹ ¸ÃÃÁ” (ÁÒµÃÒ 12)

8


¤ÇÒÁÊíҤѭ¢Í§ÁÒµÃÒ¹Õé Á؋§à¹Œ¹·ÕèµÑǼٌ»ÃСͺ¸ØáԨ·Õ赌ͧµÑé§ÁÑè¹ ã¹¤Ø³¸ÃÃÁ àº×Íé §µŒ¹·Õ¨è еŒÍ§äÁ‹àÍÒà»ÃÕº¼ÙºŒ ÃÔâÀ¤ ÊÔ§è ·ÕÁè §Ø‹ ์¹¤×ÍàÃ×Íè §¢Í§ ¤ÇÒÁÊبÃÔµ àÁ×èÍ¢ÂÒÂãˌ໚¹ÃÙ»¸ÃÃÁ¨Ð䴌ᡋ “Áҵðҹ·Ò§¡ÒäŒÒ ·ÕèàËÁÒÐÊÁ” áÅÐãˌÍÂً “ÀÒÂ㵌Ãкº¸ØáԨ·Õè໚¹¸ÃÃÁ” àÃ×èͧ¢Í§ Áҵðҹ໚¹ÊÔ觷Õè¼ÙŒ»ÃСͺ¸ØáԨµŒÍ§¡íÒ˹´ãˌÁÕ¢Öé¹ãˌ໚¹ä»µÒÁ Áҵðҹ¢Í§áµ‹ÅÐÍصÊÒË¡ÃÃÁ ઋ¹ ö¹µ¨ÐµŒÍ§ÁÕ¤ÇÒÁ»ÅÍ´ÀÑ 㹡ÒÃ¢Ñ º ¢Õè ÁÕ Ã ÐººËŒ Ò ÁŌ Í ·Õè ÁÕ » ÃÐÊÔ · ¸Ô À Ò¾ ÁÕ ¶Ø § ÅÁ¹Ô à ÀÑ Â àÇÅÒ à¡Ô´ÍغµÑ àÔ ËµØ ¶ŒÒ໚¹¹Ò́¡Ò ¨ÐµŒÍ§à´Ô¹à·ÕÂè §µÃ§ ¶ŒÒ໚¹ÍÒËÒÃáÅÐÂÒ µŒÍ§»ÅÍ´ÀÑÂ㹡ÒúÃÔâÀ¤áÅÐäÁ‹à¡Ô´ÍѹµÃÒ¢ŒÒ§à¤Õ§ àÃ×Íè §¢Í§Ãкº¸ØáԨ ·Õè໚¹¸ÃÃÁ໚¹àÃ×èͧ¢Í§¡Òû¯ÔºÑµÔµÒÁ “»¡µÔ»ÃÐླՔ ·Ò§¡ÒäŒÒ ઋ¹ àÁ×Íè ªíÒÃÐà§Ô¹ ËÃ×ÍÁÑ´¨íÒ¤‹ÒÊÔ¹¤ŒÒáÅŒÇ ¤ÇèеŒÍ§ä´ŒÃºÑ ÊÔ¹¤ŒÒ¹Ñ¹é ¤Ùʋ ­ Ñ ­Ò¨ÐÁÒÍŒÒ§Ç‹Ò äÁ‹ä´Œ·Òí ÊÑ­­Ò äÁ‹ä´ŒÅ§ÅÒÂÁ×ͪ×Íè änj໚¹ÅÒÂÅѡɳÍ¡Ñ Éà ¨Ö§·íÒãˌäÁ‹ÊÒÁÒö¿‡Í§ÃŒÍ§à»š¹¤´ÕËÒ䴌äÁ‹ à¾ÃÒлÃÐླշҧ ¡ÒäŒÒ¹Ñ¹é àÁ×Íè ¼Ù«Œ Í×é ªíÒÃÐà§Ô¹áŌǼ٢Œ Ò¡çµÍŒ §Ê‹§ÁͺÊÔ¹¤ŒÒãˌ ʋǹàÃ×Íè §¡ÒÃŧÅÒÂÁ×ͪ×Íè änj໚¹ËÅÑ¡°Ò¹ ໚¹àÃ×Íè §¢ŒÍºÑ­­ÑµÔ ·Ò§¡®ËÁÒÂᾋ§ ÁÔ㪋àÃ×èͧ¢Í§»¡µÔ·Ò§¡ÒäŒÒ ¡µÑÇÍ‹ҧ·ÕèàË繪Ѵ¤×ÍàÃ×èͧ¡ÒÃâ¦É³Ò¢ÒÂâ¤Ã§¡ÒÃËÁًºŒÒ¹¨Ñ´ÊÃà ·ÕèÁÕàÍ¡ÊÒÃàªÔ­ªÇ¹ãˌ«×éͺŒÒ¹´ŒÇÂâ¦É³ÒNjҨШѴãˌÁÕÊÃÐNjÒ¹éíÒ ÁÕʹÒÁà´ç¡àŋ¹ ÁÕâçàÃÕ¹͹غÒÅÀÒÂã¹ËÁًºŒÒ¹ ·íÒãˌ»ÃЪҪ¹Ëŧàª×èÍ ¨Í§«×éͺŒÒ¹µÒÁ·Õèâ¦É³Òänj¹Ñé¹ áµ‹áŌÇâ¤Ã§¡ÒáçÁÔ䴌ÊÌҧʋǹ¡ÅÒ§änjµÒÁâ¦É³Ò ઋ¹¹Õé ¶×ÍNjҷҧâ¤Ã§¡ÒÃËÁًºŒÒ¹äÁ‹»¯ÔºÑµÔµÒÁÁҵðҹ·Ò§¡ÒäŒÒ·ÕèàËÁÒÐÊÁ ¡Ã³Õઋ¹¹Õé¨Ð¿‡Í§ÃŒÍ§àÍÒ¼Ô´µÒÁ¡®ËÁÒÂᾋ§ Ẻà´ÔÁ¨ÐºÑ§¤ÑºàÍҼԴ਌Ңͧâ¤Ã§¡ÒÃ䴌ÅíÒºÒ¡ à¾ÃÒÐʋǹ¡ÅÒ§àËŋҹÕéÁÔ䴌ÃкØänjã¹ÊÑ­­Ò«×éÍ¢ÒºŒÒ¹ à¾Õ§ᵋ ໚¹àÍ¡ÊÒÃἋ¹»ÅÔÇâ¦É³Ò·ÕÍè ÂÙ¹‹ Í¡ÊÑ­­Ò«×Íé ¢Ò ᵋàÁ×Íè ÁÕ¡®ËÁÒÂÇÔ¸¾Õ ¨Ô ÒóҤ´Õ¼ºÙŒ ÃÔâÀ¤ºÑ§¤ÑºãªŒáÅŒÇ à»š¹¡ÒÃáÊ´§ ¤ÇÒÁäÁ‹ÊبÃÔµ¢Í§à¨ŒÒ¢Í§â¤Ã§¡ÒÃËÁًºŒÒ¹ äÁ‹ä´Œ´íÒçµ¹ÍÂًÀÒÂ㵌Ãкº¸ØáԨ·Õè໚¹¸ÃÃÁ ÈÒÅÊÒÁÒö㪌´ØžԹԨ ºÑ§¤Ñºãˌ਌ҢͧËÁÙº‹ Ҍ ¹ÊÌҧʋǹ¡ÅÒ§µ‹Ò§æ àËŋҹѹé ËÃ×ͺѧ¤Ñºãˌª´ãªŒ¤Ò‹ ÊÔ¹äËÁ·´á·¹¡ç䴌 ¹Õ¤è Í× ¤ÇÒÁÈÑ¡´ÔÊì ·Ô ¸Ô¢ì ͧ “¤ÇÒÁÊبÃÔµ” «Ö§è ໚¹¤Ø³¸ÃÃÁ·Õ¼è »ÙŒ ÃСͺ¸ØáԨ¨ÐµŒÍ§ÁÕ

¤ÇÒÁÊبÃÔµ¢Í§¼ÙŒ»ÃСͺ¡ÒÃ

¾ÃÐÃÒªºÑ­­ÑµÔÇÔ¸Õ¾Ô¨ÒóҤ´Õ¼ÙŒºÃÔâÀ¤ ¾.È.2551 ໚¹¡®ËÁÒ·Õèᵡµ‹Ò§¨Ò¡ÇÔ¸Õ¡ÒþԨÒóҤ´Õᾋ§ ໚¹Í‹ҧÁÒ¡ à¾ÃÒÐãˌÍíÒ¹Ò¨ÈÒÅ㪌´ØžԹԨ㹡ÒôíÒà¹Ô¹¡Ãкǹ¾Ô¨ÒóÒÊÑ觡ÒÃ䴌 ઋ¹ ¡ÒÃᡌä¢ÊÔ觼ԴÃÐàºÕº ¼Ô´Ëŧ·ÕèÁÕã¹Êíҹǹ¤ÇÒÁ ¡ÒÃÊÑè§Â‹¹ËÃ×Í¢ÂÒÂÃÐÂÐàÇÅÒ䴌 ¡ÒÃàÃÕ¡¤×¹ (Recall) ÊÔ¹¤ŒÒ·Õ躡¾Ã‹Í§ ¡ÒÃãˌà»ÅÕè¹ ÊÔ¹¤ŒÒãËÁ‹á·¹¡Òë‹ÍÁá«ÁÊÔ¹¤ŒÒ·ÕèªíÒÃØ´ áÅСÒÃÊÑ觨‹Ò¤‹ÒàÊÕÂËÒÂàªÔ§Å§â·É (Punitive damage) 䴌 ¡Ò÷ÕèÈÒÅ ¨ÐÊÑ§è ¡ÒÃã´æ ´Ñ§¡Å‹ÒÇ¢ŒÒ§µŒ¹¹Õé ÈÒŨÐ㪌´ÅØ ¾Ô¹¨Ô ã¹àÃ×Íè §¤ÇÒÁÊبÃÔµ (Act in good faith) ¢Í§¼Ù»Œ ÃСͺ¸ØáԨ໚¹ËÅÑ¡ ·Ñ§é ¹Õé â´Â¤íÒ¹Ö§¶Ö§Áҵðҹ·Ò§¡ÒäŒÒ·Õàè ËÁÒÐÊÁÀÒÂ㵌Ãкº¸ØáԨ·Õàè »š¹¸ÃÃÁ¹Ñ¹è àͧ áÁŒ¤ÇÒÁäÁ‹Ê¨Ø ÃÔµ¢Í§¼Ù»Œ ÃСͺ¸ØáԨ ¨ÐäÁ‹ÁºÕ ·Å§â·É (Sanction) â´ÂµÃ§ ᵋ㹡Ãкǹ¡ÒÃáˋ§¤´Õ¼ºÙŒ ÃÔâÀ¤ ¤ÇÒÁÊبÃÔµ¢Í§¼Ù»Œ ÃСͺ¸ØáԨ¨ÐÁÕÊNj ¹ÊíҤѭ µ‹Í¡ÒÃ㪌´ÅØ ¾Ô¹¨Ô ¢Í§ÈÒÅ໚¹Í‹ҧÁÒ¡ 㹡Ò÷ըè СíÒ˹´¤‹ÒÊÔ¹äËÁ·´á·¹ ËÃ×Í¡ÒáíÒ˹´¤‹ÒàÊÕÂËÒÂàªÔ§Å§â·É (Punitive damage) 䴌

9


¤ÇÒÁÊبÃÔµ¢Í§¼ÙŒºÃÔâÀ¤

áÁŒ¾ÃÐÃÒªºÑ­­ÑµÔÇÔ¸Õ¾Ô¨ÒóҤ´Õ¼ÙŒºÃÔâÀ¤ ¾.È.2551 ¨Ð໚¹¡®ËÁÒ¤،Á¤Ãͧ¼ÙŒºÃÔâÀ¤·Õè¨Ð¿‡Í§ ÌͧàÃÕ¡¤‹ÒÊÔ¹äËÁ·´á·¹ä´Œâ´Â§‹Ò äÁ‹µÍŒ §àÊÕ¤‹Ò㪌¨Ò‹ ÂÈÒÅ (¤‹ÒĪҸÃÃÁà¹ÕÂÁ) 㪌ÃÐÂÐàÇÅÒ¾Ô¨ÒóҤ´Õ Í‹ҧÃÇ´àÃçÇ áµ‹¼ÙŒºÃÔâÀ¤·Õè¨Ð㪌ÊÔ·¸ÔàÃÕ¡Ìͧ¤ÇÒÁàÊÕÂËÒ¨еŒÍ§à»š¹¼ÙŒºÃÔâÀ¤·ÕèÁÕਵ¹ÒºÃÔÊØ·¸Ôì෋ҹÑé¹ ¶ŒÒ»ÃÒ¡¯á¡‹ÈÒÅNjҼٌºÃÔâÀ¤ËÃ×ͼٌÁÕÍíÒ¹Ò¨¿‡Í§á·¹¼ÙŒºÃÔâÀ¤¹Ñé¹¹íÒ¤´ÕÁÒ¿‡Í§â´ÂäÁ‹ÁÕà˵ØÍѹÊÁ¤ÇÃàÃÕ¡Ìͧ ¤‹ÒàÊÕÂËÒÂà¡Ô¹ÊÁ¤Çà »ÃоĵԵ¹äÁ‹àÃÕºÌÍ ÁÕ¡ÒûÃÐÇÔ§¤´Õ ÈÒÅÍÒ¨Êѧè ãˌÁ¡Õ ÒêíÒÃФ‹ÒĪҸÃÃÁà¹ÕÂÁ ·Õè ä ´Œ ÃÑ º ¡ànj ¹ ¹Ñé ¹ ¡ç ä ´Œ ¶Œ Ò äÁ‹ » ¯Ô ºÑ µÔ µ ÒÁ ÈÒÅÁÕ Íí Ò ¹Ò¨¨í Ò Ë¹‹ Ò Â¤´Õ Í Í¡¨Ò¡ÊÒúº¤ÇÒÁ¢Í§ÈÒÅ䴌 ´Ñ§¡Å‹ÒǹÕé໚¹ÁҵáÒúѧ¤Ñºãˌ¼ÙŒºÃÔâÀ¤·Õè䴌ÃѺ¤ÇÒÁàÊÕÂËÒ¨Ãԧ෋ҹÑ鹨֧¨ÐÁÕÊÔ·¸Ô¿‡Í§ÃŒÍ§ÈÒÅ䴌â´Â äÁ‹µÍŒ §àÊÕ¤‹Ò㪌¨Ò‹  ¶ŒÒ¤ÇÒÁ»ÃÒ¡¯á¡‹ÈÒÅNjҼٺŒ ÃÔâÀ¤·ÕÁè Ò¿‡Í§¤´ÕäÁ‹Ê¨Ø ÃԵ㨠¼ÅàÊÕ‹ÍÁµ¡á¡‹¼¿ÙŒ ͇ §àͧ ÂÔ§è 仡NjҹÕé ËÒ¡ÈÒÅÁÕ¤Òí ¾Ô¾Ò¡ÉÒ㹪ѹé ÊØ´·ŒÒÂáÅŒÇ (¤´Õ¶§Ö ·ÕÊè ´Ø áŌÇ) ¶ŒÒ¼ÙºŒ ÃÔâÀ¤à»š¹½†ÒµŒÍ§ÃѺ¼Ô´ (ᾌ¤´Õ) ÈÒŨÐÊѧè ãˌ¼ºÙŒ ÃÔâÀ¤¹Ñ¹é µŒÍ§à»š¹¼ÙªŒ Òí ÃФ‹ÒĪҸÃÃÁà¹ÕÂÁ·Ñ§é ËÁ´ËÃ×ͺҧʋǹµÒÁ·ÕÈè ÒÅàËç¹ÊÁ¤Çáç䴌 ¨Ö§àËç¹ä´ŒÇ‹Ò ËÒ¡¼ÙŒºÃÔâÀ¤¹íÒ¤´ÕÁÒ¿‡Í§â´ÂäÁ‹ÊبÃÔµ ¨Ð໚¹à˵Øãˌµ¹á¾Œ¤´Õ䴌 àÁ×è͹Ñ鹤‹Ò´íÒà¹Ô¹¡Òõ‹Ò§æ 㹪Ñé¹ÈÒÅ·Õè䴌ÃѺ¡Òáànj¹µÑé§áµ‹áá¹Ñé¹ ¼ÙŒºÃÔâÀ¤¹Ñ鹨еŒÍ§¶Ù¡àÃÕ¡à¡çºàÁ×èͤ´Õ¶Ö§·ÕèÊØ´ «Ö觡çÊÁà˵ØÊÁ¼Å à¾×èÍ໚¹¡ÒáÃͧãˌ´Õ¡‹Í¹·Õè¼ÙŒºÃÔâÀ¤¨Ð¹íÒ¤´ÕÁÒ¿‡Í§ ¶ŒÒÁÔ䴌à¡Ô´¤ÇÒÁàÊÕÂËÒ¨ÃÔ§ ËÃ×Í໚¹¤ÇÒÁàÊÕÂËÒ à¾Õ§àÅ硹ŒÍ·ÕÊè ÒÁÒö»ÃйջÃйÍÁÂÍÁ¤ÇÒÁ¡Ñ¹ä´Œ ¡çäÁ‹¤Çÿ‡Í§ÃŒÍ§ãˌ໚¹¤´Õ·ÃÕè ¡ÈÒÅ

¤Ø³¸ÃÃÁ¤×͸ÃÃÁÒÀÔºÒŢͧ¼ÙŒ»ÃСͺ¸ØáԨ

¾ÃÐÃÒªºÑ ­ ­Ñ µÔ ¤ ÇÒÁÃÑ º ¼Ô ´ µ‹ Í ¤ÇÒÁàÊÕ Â ËÒ·Õè à ¡Ô ´ ¢Öé ¹ ¨Ò¡ÊÔ ¹ ¤Œ Ò ·Õè ä Á‹ » ÅÍ´ÀÑ Â ¾.È.2551 »ÃСÒÈ㪌àÁ×èÍÇѹ·Õè 13 ¡ØÁÀҾѹ¸ ¾.È.2551 Áռźѧ¤ÑºàÁ×è;Œ¹¡íÒ˹´Ë¹Ö觻‚¹Ñºáµ‹Çѹ»ÃСÒÈã¹ ÃÒª¡Ô¨¨Ò¹ØມÉÒ ¾ÃÐÃÒªºÑ­­ÑµÔÇÔ¸Õ¾Ô¨ÒóҤ´Õ¼ÙŒºÃÔâÀ¤ ¾.È.2551 »ÃСÒÈ㪌àÁ×èÍÇѹ·Õè 17 ¡ØÁÀҾѹ¸ ¾.È.2551 Áռźѧ¤ÑºàÁ×Íè ¾Œ¹Ë¹Ö§è ÌÍÂá»´ÊÔºÇѹ¹Ñºáµ‹Ç¹Ñ »ÃСÒÈã¹ÃÒª¡Ô¨¨Ò¹ØມÉÒ ¡®ËÁÒ·ѧé Êͧ©ºÑº¹Õé ໚¹¡®ËÁÒ¤،Á¤Ãͧ¼ÙŒºÃÔâÀ¤·ÕèºÑ§¤Ñºà©¾ÒФً¡Ã³ÕÃÐËNjҧ¼ÙŒ»ÃСͺ¸ØáԨ¡Ñº¼ÙŒºÃÔâÀ¤â´ÂµÃ§à·‹Ò¹Ñé¹ ¤´Õã´à»š¹¤´Õ¼ÙŒºÃÔâÀ¤ËÃ×ÍäÁ‹ ãˌ»ÃиҹÈÒÅÍØ·¸Ã³à»š¹¼ÙŒÇÔ¹Ô¨©Ñ ¤íÒÇÔ¹Ô¨©Ñ¢ͧ»ÃиҹÈÒÅÍØ·¸Ã³ ãˌ à »š ¹ ·Õè ÊØ ´ ¤ÇÒÁ¾Ô È ´Òâͧ¾ÃÐÃÒªºÑ ­ ­Ñ µÔ ÇÔ ¸Õ ¾Ô ¨ ÒóҤ´Õ ¼ÙŒ º ÃÔ â À¤ ¾.È.2551 «Öè § ໚ ¹ áÁ‹ º · 㹡ÒôíÒà¹Ô¹¡Ãкǹ¡ÒþԨÒóҤ´Õ¢Í§¾ÃÐÃÒªºÑ­­ÑµÔ¤ÇÒÁÃѺ¼Ô´µ‹Í¤ÇÒÁàÊÕÂËÒ·Õèà¡Ô´¢Ö鹨ҡÊÔ¹¤ŒÒ ·Õäè Á‹»ÅÍ´ÀÑ ¾.È.2551 ¤ÇÒÁÃѺ¼Ô´ªÍº¢Í§¼Ù»Œ ÃСͺ¸ØáԨNjҨеŒÍ§´íÒçänj«§Öè Áҵðҹ·Ò§¡ÒäŒÒ·Õàè ËÁÒÐÊÁ ¾ÃŒÍÁ´ŒÇÂÃкº¸ØáԨ·Õàè »š¹¸ÃÃÁ «Ö§è ¡ç¤Í× ¼Ù»Œ ÃСͺ¸ØáԨ¨ÐµŒÍ§ÁÕ “¤Ø³¸ÃÃÁ” ¹Ñ¹è àͧ

ÇÔªÒªÕ¾àÀÊѪ¡ÃÃÁµ¡ÍÂً㹺ѧ¤Ñº¢Í§¡®ËÁÒ¤،Á¤Ãͧ¼ÙŒºÃÔâÀ¤´ŒÇÂ

ã¹ PL Law ¹Ô  ÒÁNj Ò ¼ÙŒ » ÃСͺ¡ÒÃËÁÒ妅 § ¼ÙŒ ¼ ÅÔ µ ËÃ× Í ¼ÙŒ Nj Ò ¨Œ Ò §ãˌ ¼ ÅÔ µ ¼ÙŒ ¹í Ò à¢Œ Ò ¼Ù¢Œ ÒÂÊÔ¹¤ŒÒ·Õäè Á‹ÊÒÁÒöÃкصÇÑ ¼Ù¼Œ ÅÔµ ¼Ùnj ҋ ¨ŒÒ§ãˌ¼ÅÔµ ËÃ×ͼٹŒ Òí ࢌÒ䴌 ¼Ù«Œ §Öè 㪌ªÍ×è ª×Íè ·Ò§¡ÒäŒÒ à¤Ã×Íè §ËÁÒ¡ÒäŒÒ à¤Ã×èͧËÁÒ¢ŒÍ¤ÇÒÁËÃ×ÍáÊ´§´ŒÇÂÇÔ¸Õã´æ ÍѹÁÕÅѡɳзÕè¨Ð·íÒãˌà¡Ô´¤ÇÒÁࢌÒã¨ä´ŒÇ‹Ò໚¹¼ÙŒ¼ÅÔµ ¼ÙŒÇ‹Ò¨ŒÒ§ ãˌ¼ÅÔµËÃ×ͼٹŒ Òí à¢ŒÒ à»š¹¹ÔÂÒÁ·Õ¡è ŋÒǶ֧੾ÒÐÊÔ¹¤ŒÒ෋ҹѹé áÅÐã¹¹ÔÂÒÁ¢Í§¤íÒÇ‹Ò “ÊÔ¹¤ŒÒ” ¡çËÁÒ¤ÇÒÁ¶Ö§ ੾ÒÐÊѧËÒÃÔÁ·ÃѾ·Ø¡ª¹Ô´à·‹Ò¹Ñé¹ äÁ‹»ÃÒ¡¯Ç‹ÒãˌÃÇÁ¶Ö§ “§Ò¹ºÃÔ¡ÒÔ ã´æ àÅ ᵋàÁ×è;ԨÒóҨҡ ¾ÃÐÃÒªºÑ­­ÑµÔ¤ØŒÁ¤Ãͧ¼ÙŒºÃÔâÀ¤ 2522 áÅŒÇ ¹ÔÂÒÁ¤íҼٌ»ÃСͺ¸ØáԨänjNjÒãˌÃÇÁ¶Ö§§Ò¹ºÃÔ¡ÒôŒÇ »ÃСͺ¡ÒÃã¹¾ÃÐÃÒªºÑ ­ ­Ñ µÔ ÇÔ ¸Õ ¾Ô ¨ ÒóҤ´Õ ¼ÙŒ º ÃÔ â À¤ ¾.È.2551 ¤í Ò ¹Ô  ÒÁ¢Í§ “¼ÙŒ » ÃСͺ¸Ø à ¡Ô ¨ ”

10


ãˌ à »š ¹ ¼ÙŒ µ ¡ÍÂً À ÒÂ㵌 ºÑ § ¤Ñ º ¢Í§¡®ËÁÒÂNj Ò ´Œ Ç Â¡Òä، Á ¤Ãͧ¼ÙŒ º ÃÔ â À¤áÅÐãˌ Ë ÁÒ¤ÇÒÁÃÇÁ¶Ö § ¼ÙŒ » ÃСͺ ¡ÒõÒÁ¡®ËÁÒÂà¡ÕèÂǡѺ¤ÇÒÁÃѺ¼Ô´µ‹Í¤ÇÒÁàÊÕÂËÒ·Õèà¡Ô´¢Ö鹨ҡÊÔ¹¤ŒÒ·ÕèäÁ‹»ÅÍ´ÀÑ´ŒÇ àÁ×è Í ÊÃØ » ÃÇÁ¤ÇÒÁáŌ Ç áÁŒ Nj Ò §Ò¹ºÃÔ ¡ ÒèÐäÁ‹ µ ¡ÍÂً ã ¹ºÑ § ¤Ñ º ¢Í§ PL Law ᵋ Ë Ò¡¼ÙŒ º ÃÔ â À¤¿‡ Í § àÃÕ Â ¡¤‹ Ò àÊÕ Â ËÒÂà¾ÃÒÐàËµØ Å ÐàÁÔ ´ ÊÔ · ¸Ô ¢ ͧ¼ÙŒ º ÃÔ â À¤äÁ‹ Nj Ò ¨Ðà¡Ô ´ ¨Ò¡ÊÔ ¹ ¤Œ Ò ËÃ× Í ºÃÔ ¡ ÒÃ¡ç µ ÒÁãˌ ¹í Ò ¡Ãкǹ¡Òà ÇÔ ¸Õ ¾Ô ¨ ÒóҤ´Õ ¼ÙŒ º ÃÔ â À¤ÁÒºÑ § ¤Ñ º 㪌 ÊÃØ » áŌ Ç ¼ÙŒ º ÃÔ â À¤·Õè ä ´Œ ÃÑ º ¤ÇÒÁàÊÕ Â ËÒ¨ҡ§Ò¹ºÃÔ ¡ ÒÃ¡ç ´í Ò à¹Ô ¹ ¡ÒõÒÁ ÇÔ ¸Õ ¾Ô ¨ ÒóҤ´Õ ¼ÙŒ º ÃÔ â À¤¹Ñè ¹ àͧ ´Ñ § ¡Ã³Õ ¡ ÒÃãˌ º ÃÔ ¡ Ò÷ҧ¡ÒÃᾷ Ë Ã× Í ¡ÒÃÊÒ¸ÒóÊØ¢ âç¾ÂÒºÒŢͧÃѰ໚¹Ê‹Ç¹ÃÒª¡ÒÃã¹Êѧ¡Ñ´Êíҹѡ§Ò¹ »ÅÑ´¡ÃзÃǧÊÒ¸ÒóÊØ¢ ´íÒà¹Ô¹¡Ô¨¡ÒÃãˌºÃÔ¡ÒôŒÒ¹¡ÒÃÊÒ¸ÒóÊØ¢ ᡋ»ÃЪҪ¹ â´ÂàÃÕ¡¤‹ÒÃÑ¡ÉÒ¾ÂÒºÒÅ໚¹¡Òõͺ᷹ ¨Ö§¶×Í䴌Çҋ ໚¹¼Ù㌠ˌºÃÔ¡ÒÃáÅÐ໚¹¼Ù»Œ ÃСͺ¸ØáԨ (¤íÒÇÔ¹¨Ô ©Ñ·Õè 8/2551)

¡®ËÁÒÂ໚¹ÇÔ¸Õ˹Öè§ã¹¡ÒÃᡌ»˜­ËÒ෋ҹÑé¹

ÊÃþÊÔ觺¹âÅ¡¹Õéà¡Ô´ÁÒµŒÍ§¾Ö觾ÒÍÒÈÑ«Ö觡ѹáÅСѹ·Ñé§ÊÔé¹ ÃÇÁ·Ñ駼ٌ»ÃСͺ¸ØáԨáÅмٌºÃÔâÀ¤¡çäÁ‹ÁÕ¡Òáànj¹ ¡ÒèÐÍÂً¤Ù‹¡Ñ¹ 䴌 Í Â‹ Ò §ÂÑè § Â× ¹ ¶ÒÇà ·Ñé § Êͧ½† Ò Â¨ÐµŒ Í §·í Ò Ë¹Œ Ò ·Õè á ˋ § µ¹ãˌ ´Õ ·Õè ÊØ ´ ·Ñé § ¼ÙŒ » ÃСͺ¸Ø à ¡Ô ¨ áÅмٌ º ÃÔ â À¤¨Ö § µŒ Í §ÁÕ “¤Ø ³ ¸ÃÃÁ” ÁҵáÒà ·Õè¡íÒ˹´änj㹡®ËÁÒ¤،Á¤Ãͧ¼ÙŒºÃÔâÀ¤à»š¹à¾Õ§¡µÔ¡Òàº×éͧµŒ¹ÃкØ˹ŒÒ·Õè ¤ÇÒÁÃѺ¼Ô´ªÍº¢Í§¼Ù»Œ ÃСͺ¸ØáԨ áÅÐãËŒÊ·Ô ¸Ôàº×Íé §µŒ¹á¡‹¼ºÙŒ ÃÔâÀ¤ â´ÂÈÒÅ·íÒ˹ŒÒ·Õàè »š¹¡ÃÃÁ¡ÒõѴÊԹNjÒÁս҆ Âã´àŋ¹ ½†Ò½„¹¡µÔ¡ÒËÃ×ÍäÁ‹ ¡ÒÃÁÕ¾ÃÐÃÒªºÑ­­ÑµÇÔ ¸Ô ¾Õ ¨Ô ÒóҤ´Õ¼ºÙŒ ÃÔâÀ¤ ¾.È.2551 ¹ÑºÇ‹Ò໚¹¡ÒáíÒ˹´¡®¡µÔ¡Òãˌª´Ñ ਹÂÔ§è ¢Ö¹é 㹡Ò÷ÕèÈÒŨеѴÊÔ¹¤´Õãˌà¡Ô´¤ÇÒÁÂصԸÃÃÁÂÔ觢Öé¹ áµ‹¡®ËÁÒÂ໚¹à¾Õ§ÁҵáÒÃ˹Öè§ã¹¡ÒÃᡌ䢻˜­ËÒ෋ҹÑé¹ ¤§äÁ‹ÊÒÁÒöᡌ»­ ˜ Ëҷѧé ËÁ´ä´Œ ¡ÒáíÒ˹´ãˌ¼»ÙŒ ÃСͺ¸ØáԨãˌÁ¤Õ ³ Ø ¸ÃÃÁ´Ñ§ã¹ÁÒµÃÒ 12 ¨Ö§à»š¹ÇÔ¸ËÕ ¹Ö§è ·Õ¨è зíÒãˌ ¼Ù»Œ ÃСͺ¸ØáԨãˌÁ¤Õ ³ Ø ¸ÃÃÁã¹µÑÇàͧ ËÒäÁ‹áŌÇÍÒ¨¶Ù¡¾Ô¾Ò¡ÉÒàªÔ§Å§â·É䴌 ʋǹ´ŒÒ¹¢Í§¼ÙºŒ ÃÔâÀ¤àͧ¡çµÍŒ §ÁÕ¤³ Ø ¸ÃÃÁ ´ŒÇÂઋ¹¡Ñ¹ äÁ‹¹íÒ¤ÇÒÁà·ç¨ÁÒ¿‡Í§ äÁ‹¿‡Í§ÃŒÍ§àÃÕ¡¤‹ÒàÊÕÂËÒÂà¡Ô¹¤ÇÒÁ໚¹¨ÃÔ§ ÍѹÃÇÁ¶Ö§·Ñ駡ÒÃÃÑ¡ÉÒÊÔ·¸Ô¢Í§µÑÇàͧ ¡ÒéÅÒ´«×Íé ©ÅҴ㪌 ¡ÒÃÈÖ¡ÉÒËÒ¢ŒÍÁÙÅ¡‹Í¹«×Íé ÊÔ¹¤ŒÒËÃ×Í㪌ºÃÔ¡Òà áÅÐ “¤Ø³¸ÃÃÁ” ·ÕÊè Òí ¤Ñ­¢ŒÍË¹Ö§è ¢Í§¼ÙºŒ ÃÔâÀ¤¤×Í ¡ÒúÃÔâÀ¤Í‹ҧ¾Íà¾Õ§¹Ñ¹è àͧ

“¤Ø³¸ÃÃÁ” ¤×ÍÍÐäà µÍºä´ŒäËÁ... ¶Ö§ÊÙ§ÈÑ¡´Ôì ÍѤðҹ ÊÑ¡»Ò¹ã´ ¶Ö§©ÅÒ´ ¡Ò¨¡ÅŒÒ »˜­­Ò´Õ

¶Ö§ÇÔäÅ àÅÔÈ¿‡Ò ʧ‹ÒÈÃÕ ¶ŒÒäÁ‹ÁÕ ¤Ø³¸ÃÃÁ ¡çµèíÒ¤¹ (â´Â¹ÔùÒÁ)

ºÃÃ³Ò¹Ø ¡ ÃÁ : ¤íÒ͸ԺÒ ¡®ËÁÒÂÇÔ¸¾Õ ¨Ô ÒóҤ´Õ¼ºÙŒ ÃÔâÀ¤ (¾ÔÁ¾¤ÃÑ§é ·Õè 2) ; ¹Ò¸ҹÔÈ à¡ÈǾԷ¡Ñ ɏ ¼Ù¾Œ ¾Ô Ò¡ÉÒËÑÇ˹ŒÒ¤³Ðã¹ÈÒÅ®Õ¡Ò ¡ÃÃÁ¡ÒáÄÉ®Õ¡Ò áÅÐÍ´ÕµµØÅÒ¡ÒÃÈÒÅÃÑ°¸ÃÃÁ¹Ù­

11


º·¤ÇÒÁ¾ÔàÈÉ

¹ÔÊҪŠºØµÃÊÔ§¢Ã³ ¾ÂÍÁ ÊØ¢à͹¡¹Ñ¹· áÅÐ ÇÔÃоŠÀÔÁÒŏ ˹‹Ç»¯ÔºµÑ ¡Ô ÒÃÇÔ¨ÂÑ ºÃÔ¡ÒÃÊØ¢ÀÒ¾ÃдѺ»°ÁÀÙÁÔ ¤³ÐàÀÊѪÈÒʵÏ ÁËÒÇÔ·ÂÒÅÑÂÁËÒÊÒäÒÁ Í.¡Ñ¹·ÃÇÔªÂÑ ¨.ÁËÒÊÒäÒÁ 44150, Email : phayom.s@msu.ac.th

»˜¨¨Ñ·ÕÁè ¼ Õ Åµ‹Í¡ÒÃࢌÒËÇÁ

â¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ

Factors Affecting the Pharmacy Owner to Participate in Community Pharmacy Development and Accreditation Program º·¤Ñ´Â‹Í

¡ÒÃÈÖ¡ÉÒ¹Õ¨é §Ö ÁÕ¨´Ø »ÃÐʧ¤à¾×Íè ËÒ»˜¨¨Ñ·ÕÁè ¼Õ Åµ‹Í¡ÒõѴÊÔ¹ã¨à¢ŒÒËÇÁËÃ×ÍäÁ‹à¢ŒÒËÇÁâ¤Ã§¡ÒþѲ¹Ò áÅÐÃѺÃͧ ¤Ø³ÀҾÌҹÂÒ â´Â·íÒ¡ÒÃʋ§áººÊͺ¶ÒÁ·Ò§ä»ÃɳÕÂä »Âѧ਌ҢͧÌҹÂÒá¼¹»˜¨¨Øº¹Ñ ¢Â.1 (ÌҹÂÒ·ÑÇè ä») 200 Ìҹ ã¹ 9 ¨Ñ§ËÇÑ´·Õäè ´Œ¨Ò¡¡ÒÃÊØÁ‹ ã¹à¢µÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í ä´ŒÃºÑ ¡Òõͺ¡ÅѺ¨íҹǹ 41 Ìҹ â´Â໚¹ÃŒÒ¹ÂÒ·Õàè ¢ŒÒËÇÁ â¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ 10 Ìҹ áÅÐÌҹÂÒ·ÑÇè ä» 31 Ìҹ ẺÊͺ¶ÒÁ¤Ãͺ¤ÅØÁ ¢ŒÍÁÙÅ·ÑÇè 仢ͧÌҹÂÒ ÅѡɳТͧ਌ҢͧÌҹÂÒ ÁҵðҹÌҹÂҤسÀÒ¾ áÅФÇÒÁ¤Ô´àË繢ͧ਌ҢͧÌҹÂÒ ¼Å¡ÒÃÇÔà¤ÃÒÐˏ¤ÇÒÁÊÑÁ¾Ñ¹¸ ÃÒ¢ŒÍ·ÕèÁÕ¤ÇÒÁᵡµ‹Ò§Í‹ҧÁÕ¹ÑÂÊíҤѭ·Ò§Ê¶ÔµÔ (p<0.05) ã¹ 1) ÅѡɳÐ਌ҢͧÌҹÂÒ·ÕèàË繡ÒÃà»ÅÕè¹á»Å§ ໚ ¹ àÃ×è Í §·Œ Ò ·ÒÂáÅÐàµÃÕ Â Á¾ÃŒ Í Á 2) ¨í Ò ¹Ç¹¤ÃÑé § 㹡ÒÃࢌ Ò Ã‹ Ç ÁͺÃÁ 㹡Å؋ Á ·Õè à ¢Œ Ò Ã‹ Ç Áâ¤Ã§¡ÒÃ¾Ñ ² ¹ÒÏ 3) ÃÐÂÐàÇÅÒà©ÅÕèÂ㹡ÒÃແ´ÃŒÒ¹ÂÒ 4) ÃÒÂ䴌µ‹ÍÇѹ 5) àÀÊѪ¡ÃàµçÁàÇÅÒ 6) ¡Òû¯ÔºÑµÔµÒÁÁҵðҹ áÅÐ 7) ¤ÇÒÁ¤Ô´àËç¹µ‹Í¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ ¹Í¡¨Ò¡¹ÕÂé §Ñ ¾ºÇ‹ÒÁÕÃҌ ¹ÂÒ·ÑÇè 仨íҹǹ 4 Ìҹ (ÌÍÂÅÐ 12.9) ·Õáè Ê´§¤ÇÒÁ µŒÍ§¡ÒÃࢌÒËÇÁâ¤Ã§¡ÒÃÍ‹ҧÂÔè§ «Ö觤ÇÃ䴌ÃѺ¡ÒÃʹѺʹعµ‹Íä» ¤íÒÊíҤѭ : »˜¨¨Ñ â¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ

Abstract

The main purpose of this study was to determine the attributes of the pharmacy owners making decisions to participate in the Community Pharmacy Development and Accreditation Program. The questionnaires were sent to 200 pharmacy owners in nine provinces, which were randomly sampled, in the Northeastern of Thailand. The returned questionnaires were from 10 accredited pharmacies and 31 pharmacies. The questionnaires covered general information about the pharmacy and the owners, standard criteria of accredited pharmacy and pharmacy owner’s opinion. Logistic regression analysis were used, 7 attributes which showed statistically significant relationship with the decision to be in the program, were 1) the owners’ attitude of change 2) numbers attended training 3) the age of the pharmacies 4) incomes per day 5) full time pharmacists 6) achieved standard criteria and 7) the owners’ opinion toward the program. It was interesting to find that 4 pharmacies’ owners (12.9%) highly desired to be in the program. Keywords : Factor, Community Pharmacy Development and Accreditation Program 12


º·¹íÒ

»˜¨¨Øº¹Ñ »ÃÐà·Èä·ÂÁÕÃҌ ¹ÂÒ¶×Í䴌Çҋ ໚¹áËŋ§ÊØ¢ÀÒ¾ÃдѺ»°ÁÀÙÁ·Ô »Õè ÃЪҪ¹ÊÒÁÒöࢌҶ֧䴌§Ò‹  áÅÐÊдǡ ÊÀÒàÀÊѪ¡ÃÃÁáÅÐÊíҹѡ§Ò¹¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ¨Ö§ÁÕ¡ÒüÅÑ¡´Ñ¹ÃŒÒ¹ÂÒãˌࢌÒÁÒÊÙÁ‹ ҵðҹà´ÕÂǡѹâ´ÂÁÕ¡ÒèѴµÑ§é â¤Ã§¡Òà ¾Ñ²¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ¢Ö¹é ã¹»‚ 2546 ã¹»‚ 2551 ¾ºÇ‹Ò¨Ò¡ÃŒÒ¹ÂÒá¼¹»˜¨¨Øº¹Ñ ªÑ¹é 1 ·Õ¢è ÍãºÍ¹Ø­Òµ¢ÒÂÂÒ â´ÂàÀÊѪ¡Ã (¢Â.1) ÁÕÌҹÂҤسÀÒ¾à¾Õ§ 318 Ìҹ ¤Ô´à»š¹ÃŒÍÂÅÐ 36 (Êíҹѡ§Ò¹â¤Ã§¡ÒþѲ¹ÒÌҹÂÒ, 2552) áÊ´§ãˌàËç¹Ç‹ÒÌҹÂҤسÀÒ¾ÂѧäÁ‹ä´ŒÃºÑ ¡ÒõͺÃѺ෋ҷդè Çà ¨Ò¡·Ñ§é »ÃЪҪ¹áÅмٻŒ ÃСͺ¡ÒèíҹǹÁÒ¡·ÕÁè ¡Õ ¨Ô ¡Òà ÌҹÂÒ໚¹¢Í§µ¹àͧÂѧäÁ‹àË繤ÇÒÁÊíҤѭ áÅФÇÒÁ¨íÒ໚¹ã¹¡ÒûÃѺà»ÅÕÂè ¹à¾×Íè ࢌÒÃѺÃͧ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ (ºØÃ¹Ô ·Ã µ.ÈÃÕǧɏ áÅФ³Ð, 2551) ÃÇÁ¶Ö§ÂѧäÁ‹ÊÒÁÒö»¯ÔºµÑ µÔ ÒÁÁҵðҹÌҹÂÒ 5 ´ŒÒ¹ (ÃоվÃó ©ÅͧÊØ¢ áÅФ³Ð, 2550) µÒÁ·ÕÊè ÀÒàÀÊѪ¡ÃÃÁ¡íÒ˹´à¾×Íè ¡ÒÃÃѺÃͧÌҹÂҤسÀÒ¾ ¨Ò¡¡Ò÷Õàè ¨ŒÒ¢Í§ÃŒÒ¹ÂÒ໚¹¡Åä¡ÊíҤѭ㹡ÒüÅÑ¡´Ñ¹ áÅÐࢌÒËÇÁã¹â¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ ´Ñ§¹Ñ¹é ¼Ùnj ¨Ô ÂÑ ¨Ö§µŒÍ§¡ÒÃÈÖ¡ÉÒà¾×Íè ËÒ»˜¨¨Ñ·ÕÁè ¤Õ ÇÒÁÊÑÁ¾Ñ¹¸ã¹¡ÒõѴÊÔ¹ã¨à¢ŒÒËÇÁâ¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ à¾×Íè ໚¹á¹Ç·Ò§ã¹¡ÒÃËÒ¡ÅÂØ·¸ËÃ×͹âºÒÂ㹡ÒüÅÑ¡´Ñ¹ÃŒÒ¹ÂҤسÀÒ¾µ‹Íä»

ÇÔ¸Õ¡ÒÃÈÖ¡ÉÒ

ÃٻẺ§Ò¹ÇÔ¨ÂÑ à»š¹áºº cross sectional survey «Ö§è ໚¹¡ÒÃ㪌ẺÊͺ¶ÒÁà¾×Íè ¶ÒÁ¢ŒÍÁÙÅ·ÑÇè ä»áÅФÇÒÁ¤Ô´àËç¹ ¢Í§à¨ŒÒ¢Í§ÃŒÒ¹ÂÒ·ÕèÁÕ¼Å㹡ÒõѴÊÔ¹ã¨à¢ŒÒËÇÁËÃ×ÍäÁ‹à¢ŒÒËÇÁâ¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ â´Â·íÒ¡ÒÃʋ§ ẺÊͺ¶ÒÁ·Ò§ä»ÃɳÕÂä »Âѧ਌ҢͧÌҹÂÒá¼¹»˜¨¨Øº¹Ñ ¢Â.1 (ÌҹÂÒ·ÑÇè ä») ·Õ¢è ¹Öé ·ÐàºÕ¹¡ÑºÊíҹѡ§Ò¹ÊÒ¸ÒóÊØ¢ ¢Í§áµ‹ÅШѧËÇÑ´ ã¹à¢µÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í â´Â¡íÒ˹´¨íҹǹÌҹÂÒänj·Õè 200 Ìҹ â´ÂàÅ×͡ʋ§ÃŒÒ¹ÂҤسÀÒ¾·Ø¡ÃŒÒ¹ (¨íҹǹ 28 Ìҹ) áÅСÒÃÊØÁ‹ àÅ×͡ÌҹÂÒ·ÑÇè ä»ä´Œ 9 ¨Ñ§ËÇÑ´ (¨Ò¡ 19 ¨Ñ§ËÇÑ´) áÅÐàÅ×Í¡ÊØÁ‹ ÌҹÂÒ·ÑÇè ä»ã¹áµ‹ÅШѧËÇÑ´ ãˌ䴌¨Òí ¹Ç¹ 172 Ìҹ) ẺÊͺ¶ÒÁ䴌¼Ò‹ ¹¡Ò÷´Êͺ¤ÇÒÁà·ÕÂè §µÃ§àªÔ§â¤Ã§ÊÌҧ áÅÐà¹×Íé ËҢͧà¤Ã×Íè §Á×Íâ´Â¼ÙàŒ ªÕÂè Ǫҭ´ŒÒ¹àÀÊѪ¡ÃÃÁ 3 ·‹Ò¹ â´ÂẺÊͺ¶ÒÁ¤Ãͺ¤ÅØÁ 6 ʋǹ ¤×Í 1) ¢ŒÍÁÙÅ·ÑÇè 仢ͧ਌ҢͧÌҹÂÒ 2) ¢Í§ÃŒÒ¹ÂÒ 3) ẺÊͺ¶ÒÁÅѡɳР¹ÔÊÂÑ ¢Í§à¨ŒÒ¢Í§ÃŒÒ¹ÂÒ¨íҹǹ 4 ¢ŒÍ 㪌 visual analog scale (1-10) 4) ẺÊͺ¶ÒÁ¡Òû¯ÔºµÑ µÔ ÒÁÁҵðҹÌҹÂÒ ¨íҹǹ 13 ¢ŒÍ (䴌/äÁ‹ä´Œ) 5) ẺÊͺ¶ÒÁ¤ÇÒÁ¤Ô´àË繢ͧ਌ҢͧÌҹÂÒ¨íҹǹ 21 ¢ŒÍ 㪌 Likert scale 5 ÃдѺ ¨Ò¡ÃдѺ·Õè 1 “äÁ‹àËç¹´ŒÇÂÍ‹ҧÂÔ§è ” ¶Ö§ÃдѺ·Õè 5 “àËç¹´ŒÇÂÍ‹ҧÂÔ§è ” ¡ÒÃá»Ã¼Åẋ§ÃдѺ¤Ðá¹¹ â´Â¤Ô´¤Ðá¹¹ÊÙ§ÊØ´ ź¤Ðá¹¹µèíÒÊØ´ ËÒôŒÇ¨íҹǹª‹Ç§ªÑ鹤Ðá¹¹ (Spector PE, 1992) 䴌 1.00-1.80 (µŒÍ§¡ÒÃãˌÁÕ¹ŒÍ·ÕèÊØ´) 1.81-2.60 (µŒÍ§¡ÒÃãˌÁ¹Õ ͌ Â) 2.61-3.40 (µŒÍ§¡ÒÃãˌÁ»Õ Ò¹¡ÅÒ§) 3.41-4.20 (µŒÍ§¡ÒÃãˌÁÁÕ Ò¡) áÅÐ 4.21-5.00 (µŒÍ§¡ÒÃãˌÁÕÁÒ¡·ÕèÊØ´) áÅÐ 6) ẺÊͺ¶ÒÁ¤íÒ¶ÒÁ»ÅÒÂແ´ 1 ¢ŒÍ ÇÔà¤ÃÒÐˏ¢ŒÍÁÙÅ·ÑèÇ仵ÑÇá»Ã¹ÒÁºÑ­­ÑµÔ â´ÂáÊ´§à»š¹¤ÇÒÁ¶ÕÃè ͌ ÂÅÐ ÇÔà¤ÃÒÐˏ ËÒ¤ÇÒÁÊÑÁ¾Ñ¹¸ÃÒ»˜¨¨ÑÂâ´Â㪌ʶԵ¡Ô ÒÃÇÔà¤ÃÒÐˏ¶´¶ÍÂẺÅͨÕʵԡ (logistic regression analysis) áÅÐÇÔà¤ÃÒÐˏ ¤íÒ¶ÒÁ»ÅÒÂແ´´ŒÇÂà¹×Íé ¤ÇÒÁ (thematic analysis)

¼Å¡ÒÃÈÖ¡ÉÒ

â´ÂÁÕ¡Òõͺ¡ÅѺ·Ò§ä»ÃɳՏ·Ñé§ËÁ´ 41 Ìҹ (ÌÍÂÅÐ 21.0) ẋ§à»š¹ÃŒÒ¹ÂÒ·ÕèࢌÒËÇÁâ¤Ã§¡ÒþѲ¹Ò áÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ 10 Ìҹ áÅÐÌҹÂÒ·ÑÇè ä» 31 Ìҹ ʋǹãË­‹ÃҌ ¹ÂҤسÀҾ਌Ңͧ໚¹àÀÊѪ¡Ã¼Ù»Œ ¯ÔºµÑ §Ô Ò¹ (ÌÍÂÅÐ 80) ÌҹÂÒ·ÑÇè 令ÃÖ§è Ë¹Ö§è ·Õàè ¨ŒÒ¢Í§ÃŒÒ¹à»š¹àÀÊѪ¡Ã (ÌÍÂÅÐ 51.6) ਌ҢͧÌҹÂҤسÀҾࢌÒËÇÁͺÃÁÊÙ§¡Ç‹Ò ÌҹÂÒ·ÑÇè ä» (4.6 ± 3.0 áÅÐ 1.5 ± 1.4) ÃÐÂÐàÇÅÒ㹡ÒÃແ´ÃŒÒ¹ÂҢͧÌҹÂҤسÀÒ¾à©ÅÕÂè ¹Ò¹¡Ç‹ÒÌҹÂÒ·ÑÇè ä» (26.0 ± 17.8 áÅÐ 14.7 ± 12.4) ´Ñ§µÒÃÒ§·Õè 1 ¡ÒûÃÐàÁÔ¹â´Â visual analog scale (1-10 ¤Ðá¹¹) 4 ¢ŒÍ áÊ´§ãˌàËç¹Ç‹Ò 1) ÅѡɳТͧ਌ҢͧÌҹÂҤسÀÒ¾ àËç¹Ç‹Ò¡ÒûÃСͺÇÔªÒªÕ¾àÀÊѪ¡ÃÃÁã¹ÃŒÒ¹ÂÒ¨íÒ໚¹µŒÍ§ÁÕ¡ÒÃà»ÅÕÂè ¹á»Å§Í‹ҧÁÒ¡ã¹ÃдѺ¤Ðá¹¹ÊÙ§¡Ç‹ÒÌҹÂÒ·ÑÇè ä» (8.7 ± 1.2 áÅÐ 7.2 ± 1.8) 2) ÌҹÂҤسÀÒ¾àËç¹Ç‹Òá¹Ç¤Ô´ãËÁ‹à»š¹àÃ×Íè §¾ÃŒÍÁàÊÁ͡Ѻ¡ÒÃà»ÅÕÂè ¹á»Å§ÃдѺ¤Ðá¹¹ÊÙ§ ¡Ç‹ÒÌҹÂÒ·ÑÇè ä» (8.3 ± 1.4 áÅÐ 6.9 ± 1.8) 3) ÌҹÂҤسÀÒ¾àËç¹Ç‹ÒºÃÔ¡ÒâͧÌҹÂÒÊÒÁÒöµÍºÊ¹Í§¤ÇÒÁµŒÍ§¡Òà 13


µÒÃÒ§·Õè 1 ¢Œ Í ÁÙ Å ·Ñè Ç ä»¢Í§à¨Œ Ò ¢Í§ÃŒ Ò ¹ÂÒáÅÐÌ Ò ¹ÂÒ ¢Œ Í ÁÙ Å ·Ñè Ç ä»¢Í§à¨Œ Ò ¢Í§ÃŒ Ò ¹ÂÒ à¾È: ªÒ ʶҹÀÒ¾ã¹ÃŒÒ¹ÂÒ: ਌Ңͧ ਌ҢͧáÅÐàÀÊѪ¡Ã¼Ù»Œ ¯ÔºµÑ §Ô Ò¹ ÃдѺ¡ÒÃÈÖ¡ÉÒ: µèÒí ¡Ç‹Ò»ÃÔ­­ÒµÃÕ »ÃÔ­­ÒµÃÕ¢¹Öé ä» ¡ÒÃÍÂÙ»‹ ¯ÔºµÑ ËÔ ¹ŒÒ·Õ¢è ͧàÀÊѪ¡Ã: àÀÊѪ¡ÃàµçÁàÇÅÒ ¡íÒ˹´ª‹Ç§àÇÅÒ·ÕÁè àÕ ÀÊѪ¡Ã ¡ÒÃ໚¹ÊÁÒªÔ¡ÊÁÒ¤ÁÇÔªÒªÕ¾: äÁ‹à»š¹ÊÁÒªÔ¡ÊÁÒ¤Áã´æ ໚¹ÊÁÒªÔ¡ÊÁÒ¤Á ઋ¹ ÊÁÒ¤ÁÌҹ¢ÒÂÂÒ ÍÒªÕ¾: ແ´ÃŒÒ¹¢ÒÂÂÒÍ‹ҧà´ÕÂÇ »ÃСͺÍÒªÕ¾Í×¹è ËÇÁ´ŒÇ ઋ¹ àÀÊѪ¡Ãâç¾ÂÒºÒÅ ¨íҹǹ¤Ãѧé 㹡ÒÃࢌÒËÇÁͺÃÁ »ÃЪØÁ ÊÑÁÁ¹Ò ã¹ 1 »‚ (¤Ãѧé ) (¤‹Òà©ÅÕÂè ± SD) ÃÐÂÐˋҧ¢Í§ÃŒÒ¹ÂÒ¨Ò¡áËŋ§ªØÁª¹ (¡ÔâÅàÁµÃ) (¤‹Òà©ÅÕÂè ± SD) ¢¹Ò´¢Í§ÃŒÒ¹ÂÒ (¨íҹǹ¤ÙËÒ) (¤‹Òà©ÅÕÂè ± SD) ¨íҹǹÊÒ¢Ò·Õàè »´ãˌºÃÔ¡Òà (ÊÒ¢Ò) (¤‹Òà©ÅÕÂè ± SD) ÃÐÂÐàÇÅÒ㹡ÒÃແ´ÃŒÒ¹ÂÒ (»‚) (¤‹Òà©ÅÕÂè ± SD) ÃÒÂÃѺà©ÅÕÂè µ‹ÍÇѹ¨Ò¡¡ÒâÒÂÂÒäÁ‹Ë¡Ñ µŒ¹·Ø¹ (ºÒ·) (¤‹Òà©ÅÕÂè ± SD) ¨íҹǹ¼ÙÁŒ Ò㪌ºÃÔ¡ÒÃà©ÅÕÂè ã¹áµ‹ÅÐÇѹ (¤¹) (¤‹Òà©ÅÕÂè ± SD)

¨í Ò ¹Ç¹(Ì Í ÂÅÐ) Ì Ò ¹ÂÒ¤Ø ³ ÀÒ¾ (n=10) Ì Ò ¹ÂÒ·Ñè Ç ä» (n=31) 6 (60.0) 16 (51.6) 2 (20.0) 15 (48.4) 8 (80.0) 16 (51.6) 1 (10.0) 1 (3.2) 9 (90.0) 30 (96.8) 9 (90.0) 8 (25.8) 1 (10.0) 23 (74.2) 0 (0.0) 2 (6.5) 10 (100.0) 29 (93.5) 9 (90.0) 18 (58.1) 1 (10.0) 13 (41.9) 4.6 ± 3.0 0.5 ± 0.3 1.3 ± 0.4 1.2 ± 0.6 26.0 ± 17.8 21,286.0 ± 8222.0 84.7 ± 98.1

1.5 ± 1.4 1.2 ± 2.8 1.5 ± 0.7 1.3 ± 0.6 14.7 ± 12.4 5,087.0 ± 866.0 55.7 ± 44.8

¢Í§ªØÁª¹ä´ŒÃдѺ¤Ðá¹¹ÊÙ§¡Ç‹ÒÌҹÂÒ·ÑÇè ä» (8.6 ± 2.0 áÅÐ 7.0 ± 2.0) áÅÐ 4) ÌҹÂҤسÀÒ¾ÁÕÃдѺ¤Ðá¹¹¤ÇÒÁ¾ÃŒÍÁ 㹡ÒèѴËÒãˌÁàÕ ÀÊѪ¡Ã»ÃШíÒµÅÍ´àÇÅÒ·íÒ¡ÒÃÊÙ§¡Ç‹ÒÌҹÂÒ·ÑÇè ä» (9.6 ± 0.7 áÅÐ 5.0 ± 3.3) ÁҵðҹÌҹÂÒ¾ºÇ‹ÒÌҹÂÒ·ÑèÇä»»¯ÔºÑµÔ䴌¹ŒÍÂàÁ×èÍà»ÃÕºà·Õº¡ÑºÃŒÒ¹ÂҤسÀÒ¾ ã¹Áҵðҹ·Õè 2 àÃ×Íè §¡Òúѹ·Ö¡»ÃÐÇѵ¡Ô ÒÃ㪌ÂÒÌҹÂÒ·ÑÇè ä» 12 Ìҹ (ÌÍÂÅÐ 40.0) àÃ×Íè §¡ÒÃÁÕàÀÊѪ¡ÃÍÂÙ»‹ ¯ÔºµÑ ËÔ ¹ŒÒ·Õµè ÅÍ´àÇÅÒ·íÒ¡Òà (ËÃ×Í·Õàè »´ÃŒÒ¹) ÌҹÂÒ·ÑÇè ä» 15 Ìҹ (ÌÍÂÅÐ 50.0) Áҵðҹ·Õè 3 ¡ÒúÃÔ¡ÒÃàÀÊѪ¡ÃÃÁ·Õ´è Õ ËÑÇ¢ŒÍ·Õè 2 ÁÕ¡ÒõԴµÒÁ¡ÒÃ㪌ÂÒ áÅÐÊ׺¤Œ¹»˜­ËÒ¨Ò¡¡ÒÃ㪌ÂÒ ÃŒÒ¹ÂҤسÀÒ¾»¯ÔºµÑ äÔ ´Œ 8 Ìҹ (ÌÍÂÅÐ 80.0) ÌҹÂÒ·ÑÇè ä» 15 Ìҹ (ÌÍÂÅÐ 50.0) ´Ñ§ÀÒ¾·Õè 1 ÀÒ¾·Õè 1 áÊ´§ÃŒ Í ÂÅТͧ¡Òû¯Ô ºÑ µÔ ä ´Œ µ ÒÁÁҵðҹÌ Ò ¹ÂÒ¤Ø ³ ÀÒ¾¢Í§ÃŒ Ò ¹ÂÒ¤Ø ³ ÀÒ¾áÅÐÌ Ò ¹ÂÒ·Ñè Ç ä»

Á 1-1 ¤×ÍÁҵðҹ·Õè 1 ¢ŒÍ 1 àÃÕ§µÒÁÅíҴѺ 14


µÒÃÒ§·Õè 2 ¼Å¡ÒÃà»ÃÕ Â ºà·Õ  ºÃÐ´Ñ º ¤Ðá¹¹¤ÇÒÁ¤Ô ´ àËç ¹ ¢Í§à¨Œ Ò ¢Í§ÃŒ Ò ¹ÂÒÃÐËNj Ò § Ì Ò ¹ÂÒ¤Ø ³ ÀÒ¾áÅÐÌ Ò ¹ÂÒ·Ñè Ç ä» ¤í Ò ¶ Ò Á 1. ¤ÇÒÁ¤Ô´àËç¹´ŒÒ¹·ÔÈ·Ò§àªÔ§¹âºÒ 1.1 ÁͧàË繨شÂ×¹ÇÔªÒªÕ¾ªÑ´à¨¹ã¹¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ 1.2 ¶ŒÒÁÕ¡®¡ÃзÃǧ »ÃСÒÈ㪌Í‹ҧ¨ÃÔ§¨Ñ§·‹Ò¹¨ÐµÑ´ÊÔ¹ã¨à¢ŒÒËÇÁ 1.3 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾¨Ð·íÒãˌÃҌ ¹ÂÒàª×Íè Áµ‹Í Ãкº»ÃСѹÊØ¢ÀҾ䴌 1.4 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀҾ¡ÃдѺÈÑ¡ÂÀÒ¾¡ÒúÃÔ¡ÒâͧÌҹÂÒ䴌 1.5 ·‹Ò¹Áѹè ã¨Ç‹Ò໚¹ÃŒÒ¹ÂҤسÀÒ¾¨ÐÃѺÃͧ¡ÒôíÒà¹Ô¹¸ØáԨ䴌 2. ´ŒÒ¹¡ÒûÃСͺÍÒªÕ¾Í×¹è ËÇÁ´ŒÇ 2.1 ¶ŒÒ·‹Ò¹ÁÕ§Ò¹Í×è¹ ¡ÒÃÁÒແ´ÃŒÒ¹ÂÒÍ‹ҧà´ÕÂÇ à¾×Íè ໚¹ÃŒÒ¹ÂҤسÀÒ¾ äÁ‹¤Á، ¤‹Ò 2.2 ·‹Ò¹ÂѧäÁ‹à¢ŒÒ໚¹ÃŒÒ¹ÂҤسÀÒ¾à¾ÃÒÐäÁ‹ÊÒÁÒöÅÐ·Ô§é §Ò¹Í×¹è 䴌 3. »ÃÐ⪹áÅФ‹ÒµÍºá·¹ 3.1 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ÊÌҧ¤ÇÒÁᵡµ‹Ò§·Ò§¸ØáԨãˌÃҌ ¹·‹Ò¹ä´Œ 3.2 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ãˌ¼ÅµÍºá·¹¤ØÁŒ ¤‹Òµ‹Í¡ÒÃŧ·Ø¹ 3.3 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾·íÒãˌ·Ò‹ ¹ä´ŒÃºÑ ÊÔ·¸Ô»ÃÐ⪹ 3.4 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾·íÒãËŒä´ŒÃºÑ ¡ÒÃÂÍÁÃѺáÅÐàª×Íè ¶×ͨҡªØÁª¹ 3.5 ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾·íÒãËŒä´ŒÃºÑ »ÃÐ⪹ã¹¡ÒÃ໚¹áËŋ§½ƒ¡»‚ 6 4. ´ŒÒ¹¤Ø³ÀÒ¾¡ÒúÃÔ¡ÒÃã¹ÃŒÒ¹ÂÒ 4.1 ¡ÒÃÁÕàÀÊѪ¡ÃãˌºÃÔ¡ÒúҧàÇÅÒ ¡çãˌºÃÔ¡ÒäسÀҾ䴌ઋ¹à´ÕÂǡѹ 4.2 ·‹Ò¹ãˌºÃÔ¡ÒÃã¹ÃŒÒ¹ÂÒ䴌¶¡Ù µŒÍ§áÅŒÇ äÁ‹¨Òí ໚¹µŒÍ§à¢ŒÒ໚¹ÃŒÒ¹ÂҤسÀÒ¾ 4.3 ¡ÒÃÃѺ½ƒ¡§Ò¹¹ÔÊµÔ »‚ 6 ª‹ÇÂãˌ·Ò‹ ¹à¾ÔÁè ¤Ø³ÀҾ㹡ÒÃãˌºÃÔ¡ÒÃ䴌 5. ´ŒÒ¹ÁØÁÁͧ¢Í§»ÃЪҪ¹ 5.1 »ÃЪҪ¹àÅ×͡㪌ºÃÔ¡ÒÃÌҹÂÒ·‹Ò¹ äÁ‹ãª‹à¾ÃÒÐ໚¹ÃŒÒ¹ÂҤسÀÒ¾ 5.2 »ÃЪҪ¹·ÃÒº¤ÇÒÁᵡµ‹Ò§¢Í§ºÃÔ¡ÒÃÌҹÂҤسÀÒ¾ áÅÐÌҹÂÒ·ÑÇè ä» 5.3 ¤ÇÒÁµŒÍ§¡Òâͧ»ÃЪҪ¹à»š¹Ê‹Ç¹·Õ·è ҋ ¹µÑ´ÊԹ㨠ࢌÒËÇÁâ¤Ã§¡ÒþѲ¹ÒÏ 6. ´ŒÒ¹ÁҵðҹÌҹÂҤسÀÒ¾ 6.1 ࡳ±ÁҵðҹÌҹÂÒàËÁÒÐÊÁ´ÕáÅŒÇ 6.2 ·‹Ò¹¤Ô´Ç‹Ò·‹Ò¹ÊÒÁÒö»¯ÔºµÑ µÔ ÒÁ䴌·¡Ø ¢ŒÍ 7. ´ŒÒ¹¤ÇÒÁµŒÍ§¡ÒÃ㹡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ 7.1 ·‹Ò¹ÁÕ¤ÇÒÁµŒÍ§¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀҾ͋ҧÂÔ§è

¤Ðá¹¹à©ÅÕÂè * Ì Ò ¹ÂÒ¤Ø ³ ÀÒ¾ (n=10) 4.4 ± 0.5 4.6 ± 0.7 4.6 ± 0.7

±

¤‹ÒàºÕÂè §àº¹Áҵðҹ Ì Ò ¹ÂÒ·Ñè Ç ä» (n=31) 3.8 ± 0.7 4.0 ± 0.9 3.8 ± 0.8

4.5 ± 0.5 4.5 ± 0.5 4.0 ± 0.8 2.9 ± 1.1

3.9 ± 0.8 3.8 ± 0.8 3.7 ± 0.8 3.8 ± 0.5

2.5 ± 0.6 2.1 ± 1.0 3.6 ± 0.6 3.8 ± 0.9 3.2 ± 0.6 3.7 ± 0.8 4.0 ± 0.8 3.6 ± 1.0 3.1 ± 0.5 3.5 ± 1.4

3.0 ± 1.2 3.1 ± 1.4 3.3 ± 0.7 3.5 ± 1.1 3.4 ± 0.8 3.1 ± 0.9 3.2 ± 1.1 3.4 ± 0.8 2.9 ± 0.6 2.3 ± 0.9

2.1 ± 0.8 3.5 ± 1.4 2.7 ± 0.9 2.2 ± 0.8

3.0 ± 1.0 3.5 ± 0.8 2.7 ± 0.7 2.1 ± 0.8

3.0 ± 1.2

2.8 ± 1.0

3.0 ± 1.4 3.8 ± 0.9 3.7 ± 0.9 3.8 ± 0.9 4.5 ± 0.6 3.6 ± 0.7

3.3 ± 1.0 3.2 ± 0.9 3.2 ± 0.9 3.1 ± 1.1 4.5 ± 0.6 3.6 ± 0.7

*¤Ðá¹¹àµçÁ 5 ¤Ðá¹¹ 㪌 Likert scale 1-5

¤ÇÒÁ¤Ô´àË繢ͧ਌ҢͧÌҹÂҤسÀÒ¾ãˌ¤Ðá¹¹à©ÅÕÂè ÊÙ§ÊØ´ã¹´ŒÒ¹¤ÇÒÁµŒÍ§¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ áÅеèÒí ÊØ´ ã¹´ŒÒ¹ÁØÁÁͧ¢Í§»ÃЪҪ¹ (2.9 ± 1.1) ÌҹÂÒ·ÑèÇ令Ðá¹¹à©ÅÕè¤ÇÒÁ¤Ô´àËç¹ÊÙ§ÊØ´ã¹´ŒÒ¹¤ÇÒÁ¤Ô´àËç¹àªÔ§¹âºÒ (3.8 ± 0.7) áÅдŒÒ¹¡ÒûÃСͺÍÒªÕ¾Í×è¹Ã‹ÇÁ´ŒÇ (3.8 ± 0.5) áÅФÐá¹¹µèíÒÊØ´ã¹´ŒÒ¹ÁØÁÁͧ¢Í§»ÃЪҪ¹ (2.7 ± 0.7) àÁ×èÍà»ÃÕºà·Õº¤ÇÒÁᵡµ‹Ò§ÃÐËNjҧ¡Å؋Á ¾ºÇ‹Ò¤Ðá¹¹à©ÅÕèÂʋǹãË­‹ÃŒÒ¹ÂҤسÀÒ¾ÊÙ§¡Ç‹ÒÌҹÂÒ·ÑèÇä» Â¡ànj¹¤Ðá¹¹à©ÅÕ贌ҹ¡ÒûÃСͺÍÒªÕ¾Í×è¹Ã‹ÇÁ¢Í§ÃŒÒ¹ÂҤسÀÒ¾µèíҡNjÒÌҹÂÒ·ÑèÇä» (2.9 ± 1.1 áÅÐ 3.8 ± 0.5) áÅдŒÒ¹ÁØÁÁͧ¢Í§»ÃЪҪ¹ (2.7 ± 0.9, 2.7 ± 0.7 µÒÁÅíҴѺ) áÅж֧áÁŒ¤Ðá¹¹´ŒÒ¹¤ÇÒÁµŒÍ§¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾

15


µÒÃÒ§·Õè 3 »˜ ¨ ¨Ñ  ·Õè ÁÕ ¤ ÇÒÁÊÑ Á ¾Ñ ¹ ¸ ã ¹¡ÒÃµÑ ´ ÊÔ ¹ ã¨à¢Œ Ò Ã‹ Ç Áâ¤Ã§¡ÒÃ¾Ñ ² ¹ÒáÅÐÃÑ º Ãͧ¤Ø ³ ÀҾÌ Ò ¹ÂÒ »˜ ¨ ¨Ñ  ·Õè ÁÕ ¼ Å

¤‹Òà©ÅÕÂè ± ¤‹ÒàºÕÂè §àº¹Áҵðҹ p Odds 95% C.I. Ì Ò ¹ÂÒ¤Ø ³ ÀÒ¾ Ì Ò ¹ÂÒ·Ñè Ç ä» value ratio Lower Upper (n=10) (n=31)

1. à¾È : ªÒ (¨íҹǹ (ÌÍÂÅÐ)) 6 (60.0) 16 (51.6) 2. ʶҹÀÒ¾ã¹ÃŒÒ¹ÂÒ : ਌ҢͧÌҹ (¨íҹǹ (ÌÍÂÅÐ)) 2 (20.0) 15 (48.4) 3. ÃдѺ¡ÒÃÈÖ¡ÉÒ : µèÒí ¡Ç‹Ò»ÃÔ­­ÒµÃÕ (¨íҹǹ (ÌÍÂÅÐ)) 1 (10.0) 1 (3.2) 4. ¡ÒÃÍÂÙ»‹ ¯ÔºµÑ ËÔ ¹ŒÒ·Õ¢è ͧàÀÊѪ¡Ã :àµçÁàÇÅÒ (¨íҹǹ (ÌÍÂÅÐ)) 9 (90.0) 8 (25.8) 5. ¡ÒÃ໚¹ÊÁÒªÔ¡ÊÁÒ¤ÁÇÔªÒªÕ¾ :໚¹ (¨íҹǹ (ÌÍÂÅÐ)) 10 (100.0) 29 (93.5) 6. ÍÒªÕ¾Í×¹è æ ¹Í¡¨Ò¡»ÃШíÒ·ÕÃè Ҍ ¹ÂÒ (¨íҹǹ (ÌÍÂÅÐ)) 1 (10.0) 13 (41.9) 7. ¨íҹǹ¤Ãѧé ͺÃÁ (¤Ãѧé /»‚) 4.6 ± 3.0 1.5 ± 1.4 0.5 ± 0.3 1.2 ± 2.8 8. ÃÐÂÐˋҧ¨Ò¡ªØÁª¹ (¡ÔâÅàÁµÃ) 9. ¢¹Ò´ÃŒÒ¹ (¤ÙËÒ) 1.3 ± 0.4 1.5 ± 0.7 10. ¨íҹǹÊÒ¢Ò (ÊÒ¢Ò) 1.2 ± 0.6 1.3 ± 0.6 11. ÃÐÂÐàÇÅÒແ´ÃŒÒ¹ (»‚) 26.0 ± 17.8 14.7 ± 12.4 12. ÃÒÂ䴌 (ºÒ·/Çѹ) 21,286.0 ± 8,222.05,087.0 ± 866.0 13. ¨íҹǹÅÙ¡¤ŒÒ (¤¹/Çѹ) 84.7 ± 98.1 55.7 ± 44.8 14. ÅѡɳÐ਌ҢͧÌҹÂÒ (¤Ðá¹¹) 8.8 ± 1.1 6.6 ± 1.7 15. ¡Òû¯ÔºÑµÔ䴌µÒÁÁҵðҹÌҹÂÒ (¤Ðá¹¹)* 12.5 ± 0.9 9.5 ± 2.6 16. ¤ÇÒÁ¤Ô´àËç¹µ‹Í¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ (¤Ðá¹¹)** 77.4 ± 6.8 68.6 ± 10.4

0.644 0.128 0.411 0.004 0.999 0.999 0.017 0.484 0.239 0.782 0.048 0.039 0.224 0.006 0.004 0.028

1.5 3.7 0.3 25.9 5.6 7.3 1.5 0.6 0.4 0.8 1.2 1.0 1.0 2.8 2.8 1.1

0.2 0.7 0.0 1.1 0.0 0.0 1.1 0.2 0.2 0.2 1.0 1.2 0.1 1.4 1.4 1.0

15.5 20.6 4.2 10.6 5.4 1.1 2.2 2.3 1. 9 3.3 1.1 1.4 1.0 6.0 5.8 1.2

* 㪌¤Ðá¹¹ÃÇÁµÒÁÁҵðҹ 5 ´ŒÒ¹¢Í§â¤Ã§¡ÒþѲ¹ÒÃѺÃͧÌҹÂҤسÀÒ¾ ¤Ðá¹¹àµçÁ 13 ¤Ðá¹¹ ** ¤ÇÒÁ¤Ô´àËç¹µ‹Í¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ 21 ¢ŒÍ ẋ§ÃдѺ Likert scale 1-5, 㪌¤Ðá¹¹ÃÇÁàµçÁ 105 ¤Ðá¹¹

ã¹ÃŒÒ¹ÂÒ·ÑÇè 仨еèÒí ¡Ç‹Ò áµ‹àÁ×Íè »ÃÐàÁÔ¹¤ÇÒÁ¶Õ¾è ºÇ‹ÒÌҹÂÒ·ÑÇè ä»áÊ´§¤ÇÒÁµŒÍ§¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀҾ͋ҧÂÔ§è 4 Ìҹ ¨Ò¡ 31 Ìҹ (ÌÍÂÅÐ 12.9) ´Ñ§µÒÃÒ§·Õè 2 ¨Ò¡¡ÒÃÇÔà¤ÃÒÐˏ¤ÇÒÁÊÑÁ¾Ñ¹¸ÃÒ¢ŒÍ 16 ¢ŒÍ ¾ºÇ‹Ò»˜¨¨Ñ·ÕÁè ¤Õ ÇÒÁÊÑÁ¾Ñ¹¸µÍ‹ ¡ÒõѴÊÔ¹ã¨à¢ŒÒËÇÁâ¤Ã§¡ÒþѲ¹Ò áÅÐÃѺÃͧ¤Ø³ÀҾÌҹÂÒ·Õ¾è º¤ÇÒÁᵡµ‹Ò§Í‹ҧÁÕ¹ÂÑ ÊíҤѭ·Ò§Ê¶ÔµÔ (p < 0.05) 䴌ᡋ 1) ¡ÒÃÍÂÙ»‹ ¯ÔºµÑ ËÔ ¹ŒÒ·Õ¢è ͧàÀÊѪ¡Ã 2) ¨íҹǹ¤ÃÑ§é ¢Í§¡ÒÃࢌÒËÇÁ»ÃЪØÁ 3) ÃÐÂÐàÇÅÒ¡ÒÃແ´ÃŒÒ¹ 4) ÃÒÂ䴌¢Í§ÃŒÒ¹ 5) ÅѡɳÐ਌ҢͧÌҹÂÒ 6) »¯ÔºµÑ µÔ ÒÁ ࡳ±ÁҵðҹÌҹÂÒ䴌 áÅÐ 7) ¤ÇÒÁ¤Ô´àË繢ͧ਌ҢͧÌҹ ´Ñ§µÒÃÒ§·Õè 3

¤ÇÒÁ¤Ô´àË繢ͧ਌ҢͧÌҹÂÒ¨Ò¡¤íÒ¶ÒÁ»ÅÒÂແ´ »˜¨¨ÑÂÊíҤѭ·Õ跋ҹµÑ´ÊÔ¹ã¨à¢ŒÒËÇÁËÃ×ÍäÁ‹à¢ŒÒËÇÁâ¤Ã§¡ÒþѲ¹ÒÏ

16

਌ҢͧÌҹÂҤسÀҾࢌÒËÇÁâ¤Ã§¡ÒþѲ¹ÒÃѺÃͧ¤Ø³ÀҾÌҹÂÒ à¾ÃÒÐáÊ´§º·ºÒ·¢Í§àÀÊѪ¡Ããˌª´Ñ ਹÂÔ§è ¢Ö¹é µŒÍ§¡ÒÃàËç¹ÃٻẺ¡ÒþѲ¹Òä»ã¹·ÔÈ·Ò§à´ÕÂǡѹ ÁÕẺἹËÇÁ¡Ñ¹ ແ´âÍ¡ÒÊãˌ¡ºÑ µÑÇàͧ㹡ÒÃàÃÕ¹Ãٌ ໚¹¡ÒÃÊÌҧ ¤ÇÒÁᵡµ‹Ò§áÅоѲ¹Òãˌ໚¹Ê‹Ç¹Ë¹Ö觢ͧÃкº»ÃСѹÊØ¢ÀÒ¾¢Í§ÃÑ° “ãˌ໚¹á¹Ç·Ò§»¯ÔÃÙ»·ÕèàËÁ×Í¹æ ¡Ñ¹ äÁ‹ãª‹µ‹Ò§¤¹µ‹Ò§·íÒ ¶Ù¡ºŒÒ§¼Ô´ºŒÒ§” [A3] “ÍÂҡ໚¹àÀÊѪ¡ÃªØÁª¹ ·Õè´ÕáÅл¯ÔºÑµÔ´Ñ§¹Ñé¹ÍÂً¡‹Í¹¡ÒÃࢌÒËÇÁ ໚¹¡ÒÃແ´âÍ¡ÒÊãˌÁÕ¤¹Í×è¹ÁÒª‹Ç¾Ѳ¹ÒµÑÇàÃÒãˌ´Õ¢Öé¹...«Ö觡‹Í¹Ë¹ŒÒ¹Õé ÍÂÒ¡·íÒ´ÕᵋäÁ‹Ã¨ÙŒ зíÒÍ‹ҧäà áÅÐàÁ×Íè ࢌÒËÇÁáŌÇÂÔ§è ṋã¨Ç‹Ò ¹Õáè ËŋФ×ÍÊÔ§è ·Õàè ÃÒÍÂÒ¡·íÒÍÂÙá‹ ÅŒÇ áµ‹äÁ‹Ã¨ÙŒ ÐàÃÔÁè Âѧ䧔 [A6] “ÊÌҧ¤ÇÒÁᵡµ‹Ò§¨Ò¡ÃŒÒ¹¢ÒÂÂÒÍ×蹔 [A1] “ÊÌҧ¤ÇÒÁᵡµ‹Ò§ã¹ÍÒªÕ¾·ÕèÁÕ¡ÒÃ㪌ÇԪҪվ͋ҧÊÁºÙó/ à¾×èÍãˌÊÍ´¤ÅŒÍ§¡Ñº¡Òû¯ÔÃٻ䴌¢Í§ÊËÇÔªÒªÕ¾ â´Â੾ÒдŒÒ¹àǪ¡ÃÃÁ” [A3] “à¾×èÍ¡ÃдѺÁҵðҹ¡ÒûÃСͺ ÇÔªÒªÕ¾àÀÊѪ¡ÃÃÁªØÁª¹” [A2] “µŒÍ§¡ÒÃãˌÃҌ ¹ÂÒ໚¹Ãкº·ÕÊè ÒÁÒöàª×Íè Áµ‹Í¡ÑºÃкº»ÃСѹÊØ¢ÀÒ¾¶ŒÇ¹Ë¹ŒÒ¢Í§ÃѰ䴌ઋ¹¡Ñ¹” [A1] “à¾×Íè ãˌ ¼ÙºŒ ÃÔâÀ¤ä´ŒÃºÑ ¡ÒúÃÔ¡Ò÷մè Õ à»š¹·Õ¾è §Öè ¾Ò¡Ñ¹ã¹ÃÐÂÐÂÒÇ ¼ÙºŒ ÃÔâÀ¤ÁÕ¤ÇÒÁÁѹè ã¨áÅÐänjÇÒ§ã¨ÁÒ¡¡Ç‹Ò¡ÒâÒÂÂÒ â´Â์¹´ŒÒ¹ ÃÒ¤Ò¶Ù¡à¾Õ§Í‹ҧà´ÕÂǔ [A4]


਌ҢͧÌҹÂÒ·ÑÇè ä»äÁ‹à¢ŒÒËÇÁâ¤Ã§¡ÒùÕé à¾ÃÒÐà˵ؼŷҧ¸ØáԨ ´ŒÇ¡ÒÃŧ·Ø¹ÊÙ§ ¤ÇÒÁäÁ‹¾ÃŒÍÁµÒÁࡳ± Áҵðҹ ¼ÅµÍºá·¹¡ÒÃࢌÒËÇÁäÁ‹¤ØŒÁ¤‹Ò »ÃЪҪ¹ÂѧäÁ‹àË繤ÇÒÁᵡµ‹Ò§ äÁ‹ÁÑè¹ã¨Ç‹Ò໚¹ÃŒÒ¹ÂҤسÀÒ¾áŌǨÐÁÕ ËÅÑ¡»ÃСѹ·Õáè ¹‹¹Í¹ ¨Ðä´ŒÃºÑ ¡ÒôÙáŨҡ˹‹Ç§ҹ·Õàè ¡ÕÂè Ç¢ŒÍ§ÁÒ¡¹ŒÍÂà¾Õ§㴠“¼ÅµÍºá·¹¨Ò¡¡ÒÃࢌÒËÇÁ... ઋ¹ ໚¹ÃŒÒ¹ÂҤسÀÒ¾áŌÇ䴌ÊÔ·¸Ô¢ÂÒÂÌҹÂÒ໚¹ÃŒÒ¹ health product ¨Ò¡ºÃÔÉÑ··Õè˹‹Ç§ҹ¡ÅÒ§·ÕèàÀÊѪ¡Ã·Ñ駻ÃÐà·ÈËÃ×ÍÊÁÒ¤ÁÌҹÂÒµÑ駢Öé¹ ´ÙáÅÃÒ¤Ò¾ÔàÈÉᢋ§¢Ñ¹¡ÑºÃŒÒ¹Êдǡ«×éÍÍ×è¹æ ...Í‹ҧ¹Õ¤é ͋ ¹‹Òʹ㨔 [N1] “äÁ‹àËç¹´ŒÇÂâ´Â»˜¨¨ÑÂËÅÑ¡ à¹×Íè §¨Ò¡¼ÅµÍºá·¹·ÕÁè ¡Õ ÒÃŧ·Ø¹·ÕÊè §Ù ¼ÅµÍºá·¹µèÒí ” [N21] “¤‹Ò㪌¨Ò‹ Â㹡ÒûÃѺ»ÃاÌҹ” [N27] “ÁҵáÒúҧ¢ŒÍäÁ‹Êдǡ ઋ¹ ¡ÒõԴÊÕ à»Å×ͧ” [N3] “»˜¨¨Ñ¢ŒÍà´ÕÂǤ×ÍÁÕàÀÊѪ¡Ã »ÃШíÒÌҹµÅÍ´àÇÅÒ·íÒ¡Òà à¹×Íè §¨Ò¡àÀÊѪ¡Ã·íÒ§Ò¹âç¾ÂÒºÒÅ´ŒÇ¨֧äÁ‹µ´Ñ ÊÔ¹ã¨à¢ŒÒËÇÁ” [N4] “¡ÒûÃЪÒÊÑÁ¾Ñ¹¸¹ÍŒ Âä»Ë¹‹Í ªÒǺŒÒ¹·ÑÇè ä»ÂѧäÁ‹Ã¨ÙŒ ¡Ñ »‡ÒÂÂѧäÁ‹à¢ŒÒµÒªÒǺŒÒ¹ äÁ‹àËÁ×͹»‡ÒÂàªÅŏªÇ¹ªÔÁ” [N25] “äÁ‹Á¹Ñè ã¨Ç‹Ò˹‹Ç§ҹ¢Í§ÃÑ°ËÃ×Í˹‹Ç§ҹ·Õàè ¡ÕÂè Ç¢ŒÍ§¡Ñº¡ÒþѲ¹Ò¤Ø³ÀҾÌҹÂÒ¨Ðãˌ¤ÇÒÁʹ㨴ÙáÅàÍÒã¨ãʋ ໚¹¾Õàè ÅÕÂé §ÁÒ¡¹ŒÍÂà¾Õ§㴔 [N2]

ÇÔ¨ÒóáÅÐÊÃØ»¼Å

¨Ò¡¡Ò÷íÒ¡ÒÃÈÖ¡ÉÒ㹤ÃÑ駹Õé䴌ÁÕ¡ÒÃʋ§áººÊͺ¶ÒÁ·Ò§ä»ÃɳՏä»ÂѧÌҹÂÒ¨íҹǹ·Ñé§ÊÔé¹ 200 ©ºÑº ÁÕ¼·ÙŒ Òí ¡Òõͺ¡ÅѺ·Ò§ä»ÃɳÕÂà ¾Õ§ 41 ©ºÑº ÍѵÃÒ¡Òõͺ¡ÅѺ¤Ô´à»š¹ÃŒÍÂÅÐ 21.0 «Ö§è ¤‹Í¹¢ŒÒ§µèÒí ¡ÒÃÈÖ¡ÉÒÊíÒÃǨ ÌҹÂÒã¹â´Â¡ÒÃʋ§áººÊͺ¶ÒÁ·Ò§ä»ÃɳՏ¤ÃÑé§à´ÕÂÇ ÁÕÍѵÃÒ¡Òõͺ¡ÅѺÌÍÂÅÐ 28.7 (ÀÔ­­ÀÒ à»ÅÕ蹺ҧªŒÒ§ áÅФ³Ð, 2549) áÅÐ 44.6 (¹ŒÍ§àÅç¡ ºØ­¨Ù§ áÅФ³Ð, 2550) à¹×Íè §¨Ò¡ÃŒÒ¹ÂҤسÀÒ¾ã¹à¢µÀÒ¤ÍÔÊÒ¹ÁÕ 28 Ìҹ ¨Ö§äÁ‹ä´Œ·íÒ¡ÒÃÊ؋ÁàËÁ×͹¡ÑºÃŒÒ¹ÂÒ·ÑèÇä»·Õè·íÒ¡ÒÃÊ؋Á ÃÇÁ¶Ö§¡ÒÃÇÔà¤ÃÒÐˏ¼ÅäÁ‹ä´Œ¹íÒʶԵÔÁÒ㪌ÇÔà¤ÃÒÐˏà»ÃÕºà·Õº à¹×èͧ¨Ò¡¨íҹǹµÑÇÍ‹ҧ¹ŒÍ ¼ÙŒÇԨѵŒÍ§¡ÒÃÅ´âÍ¡Òʢͧ¤ÇÒÁºÑ§àÍÔ­·Õè·íÒãˌà¡Ô´¤ÇÒÁᵡµ‹Ò§Í‹ҧÁÕ¹ÑÂÊíҤѭ ·Ò§Ê¶ÔµÔàÁ×è͹íÒʶԵÔÁÒ㪌 ¨Ö§ÃÒ§ҹ¡ÒÃà»ÃÕºà·Õº໚¹¤‹Òà©ÅÕè Í‹ҧäáçµÒÁ¼Å¡ÒÃÈÖ¡ÉÒÊÒÁÒöáÊ´§ãˌàËç¹ ¤ÇÒÁᵡµ‹Ò§ÃÐËNjҧ¡ÅØÁ‹ ÃÐËNjҧÌҹÂҤسÀÒ¾áÅÐÌҹÂÒ·ÑÇè ä» áÅÐàËç¹·ÔÈ·Ò§¢Í§¤ÇÒÁÊÑÁ¾Ñ¹¸¢Í§»˜¨¨ÑÂàÁ×Íè ÇÔà¤ÃÒÐˏ ¤ÇÒÁÊÑÁ¾Ñ¹¸ÃÒ¢ŒÍ´ŒÇÂʶԵԡÒÃÇÔà¤ÃÒÐˏ¶´¶ÍÂẺÅͨÕʵԡ ¼Åã¹´ŒÒ¹Áҵðҹ·Õâè ¤Ã§¡ÒþѲ¹ÒÃѺÃͧÌҹÂҤسÀҾ䴌¡Òí ˹´änj ¾ºÇ‹ÒÌҹÂҤسÀÒ¾ÊÒÁÒö»¯ÔºµÑ äÔ ´Œ ·Ø¡ÁҵðҹÌÍÂÅÐ 100 ¡ànj¹Áҵðҹ·Õè 3 àÃ×Íè §¡ÒÃà¢Õ¹©ÅÒ¡ÂÒáÅСÒÃÃÒ§ҹÍÒ¡ÒÃäÁ‹¾§Ö »ÃÐʧ¤¨Ò¡¡ÒÃ㪌ÂÒ «Ö§è »¯ÔºµÑ äÔ ´ŒÁÒ¡¡Ç‹ÒÌÍÂÅÐ 80 ʋǹÌҹÂÒ·ÑÇè ä»ÁÕ¤Ðá¹¹»¯ÔºµÑ µÔ ÒÁÁҵðҹµèÒí ¡Ç‹ÒÌÍÂÅÐ 60 ã¹Áҵðҹ 2-1 Áҵðҹ 2-2 Áҵðҹ 2-3 áÅÐÁҵðҹ 3-2 áÅÐ਌ҢͧÌҹÂҤسÀÒ¾àËç¹´ŒÇÂÍ‹ҧÁҡNjÒࡳ±àËÁÒÐÊÁ áÅл¯ÔºÑµÔ䴌·Ø¡¢ŒÍ (3.8 ± 0.9) ã¹¢³Ð·ÕèÌҹÂÒ·ÑèÇä»àËç¹´ŒÇÂã¹ÃдѺ»Ò¹¡ÅÒ§ (3.2 ± 0.9) ºØÃÔ¹·Ã µ.ÈÃÕǧɏ áÅФ³Ð, 2551 䴌·º·Ç¹§Ò¹ÇÔ¨ÂÑ ã¹»‚ ¾.È.2549-2550 áÊ´§ãˌàËç¹Áҵðҹ¢ŒÍ 1, 2 áÅÐ 3 ໚¹ÍØ»ÊÃä¢Í§ÃŒÒ¹ÂÒ·ÑÇè ä» ã¹¡ÒÃࢌÒâ¤Ã§¡ÒþѲ¹ÒáÅÐÃѺÃÍ§Ï Í‹ҧäáçµÒÁÌҹÂҤسÀÒ¾·Ñ§é 45 áˋ§ áÊ´§ãˌàËç¹Ç‹Ò਌ҢͧÌҹÂҤسÀÒ¾àËç¹Ç‹Ò ࡳ±Áҵðҹ¢Í§ÊÀÒàÀÊѪ¡ÃÃÁã¹ÀÒ¾ÃÇÁÁÕ¤ÇÒÁàËÁÒÐÊÁã¹ÃдѺÁÒ¡ ÁÕ¤ÇÒÁªÑ´à¨¹à¢ŒÒ㨧‹Ò áÅйíÒä»»¯ÔºµÑ Ô ä´Œ¨ÃÔ§ (¹ŒÍ§àÅç¡ ºØ­¨Ù§ áÅФ³Ð, 2550) ã¹¢³Ðà´ÕÂǡѹÌҹÂÒ·ÑÇè ä»»¯ÔºµÑ äÔ ´Œ¹ÍŒ ÂàÁ×Íè à»ÃÕºà·Õº¡ÑºÃŒÒ¹ÂҤسÀÒ¾ ã¹Áҵðҹ·Õè 2 àÃ×Íè §¡Òúѹ·Ö¡»ÃÐÇѵ¡Ô ÒÃ㪌ÂÒ áÅÐÁҵðҹ·Õè 3 àÃ×Íè §¡ÒõԴµÒÁ¡ÒÃ㪌ÂÒ áÅÐÊ׺¤Œ¹»˜­ËÒ¨Ò¡¡ÒÃ㪌ÂÒ «Ö§è Áҵðҹ㹷ѧé Êͧ¢ŒÍ¹ÕÃé ͧÃѺ¡Òû¯ÔºµÑ §Ô Ò¹¢Í§àÀÊѪ¡Ã»ÃШíÒÌҹ«Ö§è ÌҹÂÒ·Õäè Á‹ÁàÕ ÀÊѪ¡Ã»ÃШíÒÌҹ ·íÒãˌÁҵðҹ ·Ñ§é Êͧ¢ŒÍ¹ÕÂé §Ñ äÁ‹à»š¹·Õàè ¢ŒÒ㨠ÁÕ¡Òû¯ÔºµÑ ãÔ ¹»˜¨¨Øº¹Ñ ¹ŒÍ áÅйíÒä»ãªŒä´ŒµÒèí ·ÕÊè ´Ø (ÀÔ­­ÀÒ à»ÅÕÂè ¹ºÒ§ªŒÒ§ áÅФ³Ð, 2549) ¤ÇÒÁ¤Ô´àË繢ͧ਌ҢͧÌҹÂҤسÀÒ¾áÅÐÌҹÂÒ·ÑèÇä»ÁÕ¤ÇÒÁᵡµ‹Ò§¡Ñ¹ã¹·Ø¡¢ŒÍ â´ÂÌҹÂҤسÀÒ¾ÁÕ ¤Ðá¹¹à©ÅÕÂè ÊÙ§¡Ç‹Ò·Ø¡´ŒÒ¹ ¡ànj¹ã¹ÁØÁÁͧ¢Í§»ÃЪҪ¹ÃŒÒ¹ÂҤسÀÒ¾áÅÐÌҹÂÒ·ÑÇè ä»àËç¹Ç‹Ò»ÃЪҪ¹äÁ‹ä´ŒàÅ×Í¡ÃѺ ºÃÔ¡ÒÃà¾ÃÒСÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾ (2.2 ± 0.8, 2.1 ± 0.8 µÒÁÅíҴѺ) áÅÐã¹àÃ×Íè §¡ÒûÃСͺÍÒªÕ¾Í×¹è ¨ÐàËç¹ä´ŒÇҋ ÌҹÂҤسÀÒ¾µŒÍ§¡ÒÃàËç¹´ŒÇÂã¹ÃдѺ»Ò¹¡ÅÒ§µ‹Í¡ÒûÃСͺÍÒªÕ¾Í×è¹ áµ‹ÃŒÒ¹ÂÒ·ÑèÇä»àËç¹´ŒÇÂÍ‹ҧÂÔ觵‹Í¡Òà »ÃСͺÍÒªÕ¾Í×¹è ËÇÁ´ŒÇ 17


ÌҹÂÒ·ÑÇè ä»Ê‹Ç¹ãË­‹Á¤Õ Ðá¹¹à©ÅÕÂè ¤ÇÒÁµŒÍ§¡ÒÃࢌÒËÇÁâ¤Ã§¡ÒþѲ¹ÒÏ ÍÂÙ㋠¹ÃдѺÁÒ¡ ᵋÂѧäÁ‹à¢ŒÒËÇÁ ¼Å㹤íÒ¶ÒÁ»ÅÒÂແ´Í¸ÔºÒÂNjÒà¹×èͧ¨Ò¡ÁÕ¡ÒäíÒ¹Ö§¶Ö§¤‹Ò㪌¨‹Ò¼ŵͺ᷹ ÊÔ·¸Ô»ÃÐ⪹ ¼Å¡íÒä÷Õè¨Ð䴌ÃѺ «Ö觨ҡ¡ÒÃà»ÃÕºà·ÕºÃдѺ¤Ðá¹¹¤ÇÒÁ¤Ô´àË繢ͧ਌Ңͧ ÌҹÂÒã¹´ŒÒ¹»ÃÐ⪹áÅФ‹ÒµÍºá·¹ Í‹ҧäáçµÒÁ໚¹·Õ¹è ҋ ÊÑ§à¡µÇ‹Ò ã¹¡ÅØÁ‹ ÌҹÂÒ·ÑÇè ä»ÁÕÃҌ ¹ÂÒ ¨íҹǹ 4 Ìҹ (ÌÍÂÅÐ 12.9) ·Õµè ͌ §¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀҾ͋ҧÂÔ§è «Ö§è ¤ÇÃä´ŒÃºÑ ¡ÒÃʹѺʹع µ‹Íà¹×Íè § à¾×Íè ãˌ·§Ñé 4 Ìҹ¹Õäé ´ŒÃºÑ ¡ÒÃÃѺÃͧ ã¹¢³Ð·Õàè ¨ŒÒ¢Í§ÃŒÒ¹ÂҤسÀÒ¾ãˌà˵ؼšÒÃࢌÒËÇÁ â¤Ã§¡ÒùÕé ´ŒÇÂàÃ×Íè §ÍÂÒ¡à¾ÔÁè ÈÑ¡ÂÀÒ¾¢Í§µÑÇàÀÊѪ¡Ã µŒÍ§¡ÒÃàËç¹ÃٻẺ¡ÒþѲ¹Òä»ã¹·ÔÈ·Ò§ à´ÕÂǡѹ ແ´âÍ¡ÒÊ¡ÒÃàÃÕ¹ÃÙ㌠ˌ¡ºÑ µÑÇàͧ µŒÍ§¡ÒÃÊÌҧ¤ÇÒÁᵡµ‹Ò§áÅоѲ¹Ò໚¹Ê‹Ç¹Ë¹Ö§è ¢Í§ Ãкº»ÃСѹÊØ¢ÀÒ¾¢Í§ÃÑ° ¶Ö§áÁŒÇҋ ËÅѧ¡ÒÃ໚¹ÃŒÒ¹ÂҤسÀÒ¾áÅŒÇ ¨íҹǹÅÙ¡¤ŒÒáÅÐÂÍ´¢Ò â´Âà©ÅÕÂè µ‹ÍÇѹäÁ‹áµ¡µ‹Ò§¨Ò¡¡‹Í¹¼‹Ò¹¡ÒÃÃѺÃͧ (¹ŒÍ§àÅç¡ ºØ­¨Ù§ áÅФ³Ð, 2550) »˜¨¨Ñ·ÕèáÊ´§¤ÇÒÁÊÑÁ¾Ñ¹¸ã¹¡ÒõѴÊÔ¹ã¨à¢ŒÒËÇÁâ¤Ã§¡ÒþѲ¹ÒÃѺÃͧÌҹÂҤسÀÒ¾ ¼Å¡ÒÃÇÔà¤ÃÒÐˏ¾ºÇ‹Ò ÅѡɳТͧ਌ҢͧÌҹ·Õàè ¢ŒÒËÇÁ¡ÒûÃЪØÁº‹Í ÁÕá¹Ç¤Ô´ã¹¡ÒÃàËç¹ÊÔ§è à»ÅÕè¹á»Å§à»š¹àÃ×èͧ·ŒÒ·Ò ÌҹÂÒ·Õèແ´ÁÒ¹Ò¹ ÁÕÃÒÂ䴌µ‹ÍÇѹÊÙ§ ¤ÇÒÁÊÒÁÒö㹡Ò÷íÒ µÒÁÁҵðҹ áÅÐÁÕ¤Ðá¹¹¤ÇÒÁ¤Ô´àËç¹·Ò§ÊÍ´¤ÅŒÍ§¡Ñº¹âºÒ ÁÕ¤ÇÒÁÊÑÁ¾Ñ¹¸µ‹Í¡ÒõѴÊÔ¹ã¨à¢ŒÒËÇÁâ¤Ã§¡ÒùÕé ÁÒ¡¡Ç‹Ò»˜¨¨Ñ´ŒÒ¹Í×¹è æ ¡ÒÃÊÌҧ¡ÅÂØ·¸ã¹¡ÒÃãˌÃҌ ¹ÂÒ·ÑÇè 仵ÃÐ˹ѡ¶Ö§¡ÒÃࢌÒËÇÁâ¤Ã§¡ÒþѲ¹ÒÏ ÍÒ¨¨ÐàÃÔÁè ¨Ò¡à¨ŒÒ ¢Í§ÃŒÒ¹ÂÒ â´ÂÊÃØ»¡ÒÃࢌҵѴÊÔ¹ã¨à¢ŒÒËÇÁ໚¹ÃŒÒ¹ÂҤسÀÒ¾ÊÑÁ¾Ñ¹¸ã¹àªÔ§ºÇ¡¡ÑºÃŒÒ¹ÂÒ·Õèແ´ÁÒ¹Ò¹ ÃÒÂ䴌µ‹ÍÇѹÊÙ§ ¡Òû¯ÔºµÑ µÔ ÒÁÁҵðҹ ਌ҢͧÌҹࢌÒËÇÁ»ÃЪØÁº‹Í àË繡ÒÃà»ÅÕÂè ¹á»Å§à»š¹àÃ×Íè §·ŒÒ·Ò áÅÐÁÕá¹Ç¤Ô´ÊÍ´¤ÅŒÍ§ ¡Ñº¹âºÒ «Ö§è Âѧ¤§µŒÍ§¡ÒÃÃٻẺ¡ÒÃà»ÅÕÂè ¹¤ÇÒÁ¤Ô´àËç¹ ·Ñȹ¤µÔµÍ‹ ¡ÒþѲ¹ÒÌҹÂÒÍ‹ҧµ‹Íà¹×Íè §µ‹Íä»

¡ÔµµÔ¡ÃÃÁ»ÃСÒÈ

¼Ùnj ¨Ô ÂÑ ¢Í¢Íº¾ÃФس਌Ңͧ¡Ô¨¡ÒÃÌҹÂÒ·Õàè ¢ŒÒËÇÁ§Ò¹ÇÔ¨ÂÑ ·Õãè ˌ¤ÇÒÁËÇÁÁ×Í㹡ÒÃà¡çºÃǺÃÇÁ¢ŒÍÁÙÅ¡ÒÃÇÔ¨ÂÑ ¢Í¢Íº¾ÃФس¤³ÐàÀÊѪÈÒʵÏ áÅÐÁËÒÇÔ·ÂÒÅÑÂÁËÒÊÒäÒÁ·Õè䴌ãˌ¡ÒÃʹѺʹع´ŒÒ¹§º»ÃÐÁҳ㹡ÒÃÈÖ¡ÉÒ

àÍ¡ÊÒÃ͌ Ò §ÍÔ § ¡Ñ­¨¹­Ò´Ò ¹ÔÅÇÒÊ, ¹ÀÒÅÑ ¹ÔÃÁԵáØÈÅ áÅÐÊØ·ÈÑ ÇÃó ¨ÔµÃÊØ¢ÊÁ 2549. ¤ÇÒÁ¾Ö§¾Í㨢ͧ¼ÙÌ ºÑ ºÃÔ¡Òõ‹ÍºÃÔ¡ÒâͧÌҹÂҤسÀÒ¾áÅÐÌҹÂÒ·ÑÇè ä». ÇÒÃÊÒÃÇÔªÒ¡ÒÃÊÒ¸ÒóÊØ¢ 1 Á¡ÃÒ¤Á-¡ØÁÀҾѹ¸ . 133-140. â¡ÇԷ ¡Ñ§Ê¹Ñ¹· 2529. ¡Ãкǹ¡ÒõѴÊԹ㨴ŒÒ¹¡ÒúÃÔËÒà : ¡Ãͺ¤ÇÒÁ¤Ô´·ÑÇè ä» . ¡Ãا෾Ï: ʶҺѹºÑ³±Ôµ¾Ñ²¹ºÃÔËÒÃÈÒʵÏ. Ñ ¹ÊÔ·¸Ôì 2524. »ÃÐÇѵáÔ ¹Ç¤Ô´·Ò§Êѧ¤Á. ¡Ãا෾Ï. âÍà´Õ¹ÊâµÃ. ¨íÒ¹§ ͵ÔDz ¹ŒÍ§àÅç¡ ºØ­¨Ù§ ¸ÕÃҾà ª¹Ð¡Ô¨ À¡Ã¡Ô¨ ´Í¡ÃÑ¡¡ÅÒ§ ÀÙÁÇÔ ÈÔÉ® ǧÉÒ ÈÑ¡´Ôâì ¡ÊÔ·¹Ã Êٵʹ¸Ôì áÅÐÈØÀ¡Ñ É³Ò ÂÈ»˜­­Ò. 2550. ¡Òû¯ÔºµÑ µÔ ÒÁࡳ±ÃҌ ¹ÂҤسÀÒ¾ÀÒÂËÅѧ¡ÒÃÃѺÃͧ Áҵðҹâ´ÂÊÀÒàÀÊѪ¡ÃÃÁ. KKU Res J: 12(1): 53-65. ºÇÃÃѵ¹ ºÑµÃà¨ÃÔ­ 2549. à»ÃÕºà·Õº¡ÒúÃÔ¡Ò÷ҧàÀÊѪ¡ÃÃÁÃÐËNjҧÌҹÂҤسÀÒ¾¡ÑºÃŒÒ¹ÂÒ»˜¨¨Øº¹Ñ ·ÕÁè ÊÕ Ò¢Òã¹à¢µ¡Ãا෾ÁËÒ¹¤Ã. ºÑ³±ÔµÇÔ·ÂÒÅÑ ÁËÒÇÔ·ÂÒÅÑÂÈÔŻҡÃ. ºØÃ¹Ô ·Ã µ.ÈÃÕǧɏ áÅÐÇÔÊ·Ø ¸Ôì ÃѪµÐ¾§È¸Ã. 2551. âÍ¡ÒÊáÅСÒþѲ¹ÒÌҹÂҤسÀÒ¾µÒÁÁҵðҹ 5 ´ŒÒ¹ ã¹á§‹ÁÁØ ¢Í§ÃŒÒ¹ÂÒ·ÑÇè ä» ÃŒÒ¹ÂҤسÀÒ¾ áÅмÙÌ ºÑ ºÃÔ¡ÒÃ. ÇÒÃÊÒÃàÀÊѪ¡ÃÃÁªØÁª¹. 39 (7): 30-35 ÀÔ­ØÀÒ à»ÅÕÂè ¹ºÒ§ªŒÒ§ áÅдǧ·Ô¾Â ˧ɏÊÁØ·Ã. 2549. ¤ÇÒÁ¤Ô´àË繢ͧÌҹÂÒ·ÑÇè »ÃÐà·Èµ‹ÍÁҵðҹÌҹÂҢͧÊÀÒàÀÊѪ¡ÃÃÁ. ÇÒÃÊÒÃÇÔªÒ¡ÒÃÊÒ¸ÒóÊØ¢ 1 Á¡ÃÒ¤Á ¡ØÁÀҾѹ¸. 111-122. ÁËÒÇÔ·ÂÒÅÑÂÊØ⢷ѸÃÃÁÒ¸ÔÃÒª. 2523. àÍ¡ÊÒáÒÃÊ͹ªØ´ÇÔªÒËÅÑ¡áÅÐÃкººÃÔËÒáÒÃÈÖ¡ÉÒ. ¡ÃØ§à·¾Ï .Êíҹѡ¾ÔÁ¾ ÁËÒÇÔ·ÂÒÅÑÂÊØ⢷ѸÃÃÁÒ¸ÔÃÒª. ÃоվÃó ©ÅͧÊØ¢ ±Ô¦ÁÑ ¾Ã áʧ¨Ñ¹·Ã ³Ñ°¡Ò¹µ ¾Ø·¸ÈÔžÃÊ¡ØÅ ·ÇÔµÂÕ Ò ªÑÂÊØÇÃóÃѵ¹ áÅлÂ¹Ñ¹· àËÅ×ͧ¾Ù¹ÅÒÀ. 2550. ¡ÒÃÊíÒÃǨ¤ÇÒÁ¤Ô´àË繢ͧ¼Ù»Œ ÃСͺ¡ÒÃÌҹÂÒ µ‹ÍÍØ»ÊÃä㹡ÒÃࢌÒËÇÁâ¤Ã§¡ÒÃÌҹÂҤسÀÒ¾. J Health Res; 21 (1): 44-53 ÊÁ¾§É à¡ÉÁÊÔ¹. 2516. ¡ÒúÃÔËÒçҹºØ¤¤Åá¼¹ãËÁ‹. ¡Ãا෾Ï. ä·ÂÇѲ¹¾Ò¹Ôª. ÊÁÂÈ ¹ÒÇÕ¡ÒÃ. 2519. ¾Ñ²¹Òͧ¤¡ÒÃ. ¡Ãا෾Ï. ä·ÂÇѲ¹¾Ò¹Ôª. Êíҹѡ§Ò¹â¤Ã§¡ÒþѲ¹ÒÌҹÂÒ. ÀÒ¾ÃÇÁ¡ÒáÃШÒµÑǢͧÌҹÂҤسÀҾŋÒÊØ´. ¡Í§¤Çº¤ØÁÂÒ Êíҹѡ§Ò¹¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ ¡ÃзÃǧÊÒ¸ÒóÊØ¢. Available at: www. http://newsser.fda.moph.go.th/advancepharmacy/ [17 ÊÔ§ËÒ¤Á 2552] àÊÃÔÁÈÑ¡´Ôì ÇÔÈÒÅÒÀó. 2521. ¾ÄµÔ¡ÃÃÁ¼Ù¹Œ Òí ·Ò§¡ÒÃÈÖ¡ÉÒ. á¼¹¡àÍ¡ÊÒÃáÅСÒþÔÁ¾. ½†ÒÂÇÔªÒ¡Òà ÁËÒÇÔ·ÂÒÅÑÂÈÃÕ ¹¤ÃÔ¹·ÃÇÔâò ¾ÔɳØâÅ¡. âÊÀÒ ªÙ¾¡Ô ÅØ ªÑÂ. 2518. ¨ÔµÇÔ·ÂÒ·ÑÇè ä». ¡ÃØ§à·¾Ï : âç¾ÔÁ¾ÁËÒÇÔ·ÂÒÅÑÂÃÒÁ¤íÒá˧. ͹ѹµ ࡵØǧȏ. 2516. ËÅÑ¡áÅÐà·¤¹Ô¤¡ÒÃÇҧἹ. ¡ÃØ§à·¾Ï . âç¾ÔÁ¾ÁËÒÇÔ·ÂÒÅѸÃÃÁÈÒʵÏ. ÍÀÔÃ¡Ñ É Ç§ÈÃµÑ ¹ªÑ áÅФ³Ð. 2550. ¤ÇÒÁ¤Ô´àË繢ͧ¼ÙÁŒ ÒÃѺºÃÔ¡Ò÷ÕÁè µÕ Í‹ §Ò¹ºÃÔ¡ÒâͧÌҹÂҤسÀҾ㹡Ãا෾ÁËÒ¹¤Ã. ÇÒÃÊÒÃÇÔ¨ÂÑ ÇÔ·ÂÒÈÒʵÏ¡ÒÃᾷ Á¡ÃÒ¤Á-¸Ñ¹ÇÒ¤Á 21(1). ˹ŒÒ 56-66. Kotler P. 1971. Marketing Management: Analysis, Planning, Implementation and Control. 9th ed. New Jersey: Asimon & Schuster Company. Spector PE, 1992. Summated rating scale construction: An introduction. Sage University papers series No. 82: Quantitative application in the social sciences. Sage, California. Stanton WJ and Charles F. 1987. Fundamental of Margeting. 8th ed. New York : McGraw-Hill.

18


À¡.ÇÃÒÇظ àÊÃÔÁÊÔ¹ÊÔÃÔ Êíҹѡ§Ò¹â¤Ã§¡ÒþѲ¹ÒÌҹÂÒ Êíҹѡ§Ò¹¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ

º·¤ÇÒÁ¾ÔàÈÉ

¨Ñº¡ÃÐáÊ¡ÒþѲ¹ÒÌҹÂÒ

“ÂÒ¡ÅØÁ‹ ¾ÔàÈÉ

ÊíÒËÃѺÌҹÂҤسÀÒ¾”

¡ÅÂØ·¸ÊíҤѭ»ÃСÒÃ˹Öè§ã¹¡ÒÃʋ§àÊÃÔÁãˌÌҹÂÒÁդسÀÒ¾ºÃÔ¡Ò÷Õè´Õ¤×Í ¡ÒÃÊÌҧáç¨Ù§ã¨ã¹¡ÒþѲ¹Ò ¹Í¡¨Ò¡¡ÒùíÒÌҹÂÒࢌÒËÇÁâ¤Ã§¡ÒûÃСѹÊØ¢ÀÒ¾áÅŒÇ ¡ÒèѴãˌÁÕÂÒ¡Å؋Á¾ÔàÈÉÊíÒËÃѺÌҹÂҤسÀÒ¾¡ç໚¹Íա˹Öè§ ÁҵáÒ÷ÕèÁÕ¤ÇÒÁÊíҤѭ á¹Ç¤Ô´ËÅÑ¡ÊíҤѭ¤×Í Ê׺à¹×Íè §¨Ò¡»˜­ËÒ¡ÒáÃШÒÂÂÒ ã¹»˜¨¨Øº¹Ñ ÁÕÂÒ·ÕÁè »Õ ÃÐ⪹Ê§Ù ËÅÒÂÃÒ¡Ò÷ըè Òí ໚¹ µŒÍ§¤Çº¤ØÁࢌÁ§Ç´ÁÒ¡¢Ö¹é à¹×Íè §¨Ò¡àÃÔÁè ÁÕ¡ÒùíÒä»ãªŒã¹·Ò§·Õ¼è ´Ô ઋ¹ ÂÒ¡ÅØÁ‹ ÊàµÕÂÃÍ´ª¹Ô´ÃѺ»Ãзҹ «Ö§è ¶Ù´¨Ñ´ãˌ໚¹ ÂҤǺ¤ØÁ¾ÔàÈÉ ÃŒÒ¹¢ÒÂÂÒµŒÍ§¨íÒ˹‹ÒµÒÁãºÊÑè§á¾·Âà·‹Ò¹Ñé¹ áµ‹¾ºÇ‹Òã¹»˜¨¨ØºÑ¹ÁÕ¡ÒÃÅÑ¡Åͺ¨íÒ˹‹Ò¼‹Ò¹ÃŒÒ¹ÂÒ â´ÂäÁ‹ÁãÕ ºÊѧè ᾷ ¡ÃШÒ¼‹Ò¹ÃŒÒ¹¤ŒÒ»ÅÕ¡ ¼Ù¼Œ ÅÔµÂÒá¼¹âºÃÒ³ ÊÙ¼‹ ºÙŒ ÃÔâÀ¤ ã¹·Ò§µÃ§¡Ñ¹¢ŒÒÁ ÁÕÂÒºÒ§¡ÅØÁ‹ ·Õ¨è Òí ¡Ñ´ ¡ÒèíÒ˹‹ÒÂ੾ÒÐã¹Ê¶Ò¹¾ÂÒºÒŠᵋÁÍÕ »Ø ʧ¤Ê§Ù »ÅÍ´ÀѾͷըè ÐãˌàÀÊѪ¡Ãã¹ÃŒÒ¹ÂҤسÀҾ໚¹¼Ù¡Œ ÃШÒÂÊÙ¼‹ ºÙŒ ÃÔâÀ¤ ¾ÃŒÍÁ¡Ñºãˌ¤ÇÒÁÃÙ´Œ Ҍ ¹ÂÒ·Õ¶è ¡Ù µŒÍ§ «Ö§è ÂÒ¡ÅØÁ‹ ´Ñ§¡Å‹ÒǵŒÍ§¡ÒáÒü‹Í¹»Ã¹ãˌ¡ÃШÒÂ䴌Í‹ҧ·ÑÇè ¶Ö§ ¼ÙºŒ ÃÔâÀ¤à¢ŒÒ¶Ö§§‹ÒÂÁÒ¡¢Ö¹é ઋ¹ ÂÒ¡Å؋Á·Õè㪌㹼ٌ»†ÇÂË‹͹ÊÁÃöÀÒ¾·Ò§à¾È/ÂÒ·ÕèÍÂًÃÐËNjҧµÔ´µÒÁÍÒ¡ÒÃÍѹäÁ‹¾Ö§»ÃÐʧ¤·ÕèäÁ‹ãª‹ÊÒÃà¤ÁÕãËÁ‹ ÁÕ¤ÇÒÁàÊÕÂè §µèÒí àÀÊѪ¡ÃÌҹÂҤسÀÒ¾ÁÕÈ¡Ñ ÂÀÒ¾·Õ¨è Ш‹ÒÂãˌ¼»ÙŒ dž Â䴌Í‹ҧÊÁà˵ØÊÁ¼Å äÁ‹µÍŒ §¡ÒáÒõԴµÒÁ¼Å¡ÒÃÃÑ¡ÉÒ ËÃ×Í¡ÒõÃǨËҧ¡Ò·Õè«Ñº«ŒÍ¹ ໚¹µŒ¹ ͹Ö觴ŒÇÂà˵طÕèÂÒ㹡Å؋Á´Ñ§¡Å‹ÒÇÁռٌ»†Ç·ÕèÁÕ¤ÇÒÁ¨íÒ໚¹µŒÍ§ãªŒ¨íҹǹÁÒ¡ ËÒ¡¨íÒ¡Ñ´áËŋ§¡ÃШÒÂãˌÍÂً੾ÒÐã¹Ê¶Ò¹¾ÂÒºÒÅËÃ×͵ŒÍ§ãªŒãºÊÑè§ÂÒઋ¹ã¹»˜¨¨ØºÑ¹ ¨Ö§·íÒãˌÁÕÌҹÂÒ¨íҹǹ˹Öè§ ÅÑ¡Åͺ¨íÒ˹‹ÒÂÂÒ «Öè§ã¹Ê‹Ç¹Ë¹Öè§ÍÒ¨¨Ð໚¹ÂÒ»ÅÍÁ ÌҹÂҤسÀҾ໚¹ÃŒÒ¹ÂÒ·ÕèÁÕ¡ÒèѴ¡ÒäÇÒÁàÊÕ觷Õè´Õ àÀÊѪ¡Ãã¹ÃŒÒ¹ÁÕ¤ÇÒÁ¾ÃŒÍÁ㹡ÒþѲ¹Ò¤Ø³ÀÒ¾ ã¹ÃŒÒ¹Í‹ҧµ‹Íà¹×Íè § áÅÐÂѧÁÕÁҵðҹ¡ÒûÃСͺÇԪҪվ䴌µÒÁÁҵðҹ ´Ñ§¹Ñ¹é ¨Ö§à»š¹ÃŒÒ¹ÂÒ¡ÅØÁ‹ Ë¹Ö§è ·ÕÀè Ò¤ÃÑ°Áѹè 㨠㹡ÒÃãˌÊÔ·¸Ô㹡ÒáÃШÒÂÂÒºÒ§ÃÒ¡Ò÷ÕèÁÕ»˜­ËÒ¢ŒÒ§µŒ¹ ÀÒÂã¹á¹Ç¤Ô´¢ŒÒ§µŒ¹ Êíҹѡ§Ò¹¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ¨Ö§àÃÔèÁ¹íÒËͧ¡ÒùíÒá¹Ç¤Ô´ä»Êً¡Òû¯ÔºÑµÔ´ŒÇ ÂÒ¡Å؋ÁÂÒÃÑ¡ÉÒÍÒ¡ÒÃË‹͹ÊÁÃöÀÒ¾·Ò§à¾È 3 µÑÇÂÒ ¤×Í Sildenafil («ÔÅà´¹Ò¿Å) Tadalafil (·Ò´ÒÅÒ¿Å) áÅÐ Vardenafil (ÇÒà´¹Ò¿Å) «Öè§à´ÔÁ·Ñé§ËÁ´¨Ñ´à»š¹ÂҤǺ¤ØÁ¾ÔàÈÉ·Õ赌ͧ¨‹ÒµÒÁãºÊÑè§á¾·ÂáÅШíÒ¡Ñ´ãˌ¨íÒ˹‹Ò ੾ÒÐã¹Ê¶Ò¹¾ÂÒºÒÅà·‹Ò¹Ñ¹é ·íÒãˌ¼·ÙŒ ÁÕè »Õ ­ ˜ ËÒÍÒ¡ÒÃË‹͹ÊÁÃöÀÒ¾·Ò§à¾È à¡Ô´¤ÇÒÁäÁ‹Êдǡ㹡ÒÃÃѺÂÒ ¨Ö§ ¾ÂÒÂÒÁä»ËÒ«×éÍÂÒÁÒÃѺ»Ãзҹàͧ ໚¹àËÂ×èͧ͢¡ÒÃâ¦É³ÒáÅСÒÃÅÑ¡Åͺ¨íÒ˹‹ÒÂÂÒ¼Ô´¡®ËÁÒ·ҧàÇçºä«µ ᵋ·ÕèÊíҤѭ¼ÙŒºÃÔâÀ¤äÁ‹ä´ŒÃѺ¡ÒôÙáÅáÅСÒÃãˌ¤íÒá¹Ð¹íÒ·ÕèàËÁÒÐÊÁ¨Ò¡á¾·ÂËÃ×ÍàÀÊѪ¡Ã¨¹ÍҨ䴌ÃѺÍѹµÃÒ¨ҡÂÒ ¹Ñ¹é 䴌 â´Â੾ÒмٷŒ ÁÕè »Õ ­ ˜ ËÒà¡ÕÂè ǡѺËÅÍ´àÅ×Í´ËÑÇã¨ËÃ×ͼٻŒ dž Â·Õ¡è ¹Ô ÂÒ»ÃÐàÀ· Nitrates (ä¹àµÃµ) ËÒ¡¡Ô¹ÂÒ«ÔÅà´¹Ò¿Å ࢌÒ仨ÐàÊÃÔÁÄ·¸ÔìÂÒ·íÒãˌ¤ÇÒÁ´Ñ¹àÅ×Í´Å´µèíÒŧ¨¹à¡Ô´ÍÒ¡ÒêçÍ¡áÅÐàÊÕªÕÇԵ䴌 ´Ñ§¹Ñ¹é à¾×Íè ໚¹¡ÒÃÅ´¤ÇÒÁàÊÕÂè §¨Ò¡¡ÒÃ㪌ÂÒ»ÅÍÁáÅÐà¾×Íè ª‹ÇÂà¾ÔÁè ¡ÒÃࢌҶ֧ÂÒãˌᡋ¼ºÙŒ ÃÔâÀ¤·ÕÁè ¤Õ ÇÒÁ¨íÒ໚¹ µŒÍ§ãªŒÂÒ ÍÂ. ¾Ô¨ÒóÒãˌ¨íÒ˹‹ÒÂÂÒÃÑ¡ÉÒÍÒ¡ÒÃË‹͹ÊÁÃöÀÒ¾·Ò§à¾Èã¹ÃŒÒ¹ÂÒ ·Õ輋ҹËÅѡࡳ±·ÕèÊíҹѡ§Ò¹ ¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ¡íÒ˹´ «Öè§Ê‹Ç¹Ë¹Ö觤×Í ÃŒÒ¹ÂҤسÀÒ¾ â´ÂµŒÍ§¨‹ÒµÒÁãºÊÑè§á¾·Â ã¹¢³Ð·Õ赌ͧ ¤Çº¤ØÁäÁ‹ãˌÁ¡Õ ÒÃÃÑÇè äËŢͧÂÒÍÍ¡¹Í¡ª‹Í§·Ò§¡ÒèíÒ˹‹Ò·աè Òí ˹´¹Õé Í‹ҧà¤Ã‹§¤ÃÑ´ ¤Çº¤Ù¡‹ ºÑ ¡ÒÃʋ§àÊÃÔÁãˌàÀÊѪ¡Ã ÌҹÂҤسÀÒ¾·íÒµÒÁÁҵðҹá¹ÇàÀÊѪ¡Ã»¯ÔºµÑ Ô (Pharmacy practice g=uideline) µ‹Íä» ËÅѧ¨Ò¡¹íÒËͧ´ŒÇÂÂÒ¡ÅØÁ‹ ¹Õáé ÅŒÇ ËÒ¡»ÃÐʺ¤ÇÒÁÊíÒàÃ稨Ð䴌¢ÂÒÂä»ÂѧÂÒÃÒ¡ÒÃÍ×¹è æ µ‹Íä»ã¹Í¹Ò¤µ 19


º·¤ÇÒÁ¾ÔàÈÉ

À¡.ÊÁºÑµÔ ᡌǨԹ´Ò À¡.ÀÔ­â­ Ãب¨Ô ¹Ò¡ØÅ

“¤Ù‹Á×;Ѳ¹Òµ¹àͧÊً

GPP”

໚¹à¤Ã×Íè §Á×ͪ‹Ç¾Ѳ¹ÒáÅСÃдѺ ¤Ø³ÀÒ¾ÁҵðҹàÀÊѪ¡ÃÃÁªØÁª¹

¤Ù‹ Á× Í ¡ÒÃ¾Ñ ² ¹Òµ¹àͧÊً ¡ ÒÃÁÕ ÇÔ ¸Õ » ¯Ô ºÑ µÔ ·Õè ´Õ · Ò§àÀÊÑ ª ¡ÃÃÁã¹ÃŒ Ò ¹ÂÒ (Self Development Manual on GPP in Community Pharmacy Settings) ËÃ×ͨÐàÃÕ¡ÊÑé¹æ Ç‹Ò ¤Ù‹Á×Í GPP ºÒ§·‹Ò¹¤§à¤Â䴌ÃѺ¢ŒÍÁÙÅ à¡ÕÂè ǡѺÇÔ¸»Õ ¯ÔºµÑ ·Ô ´Õè ·Õ Ò§àÀÊѪ¡ÃÃÁËÃ×Í GPP ÁÒáŌǺŒÒ§ ᵋËÅÒ·‹Ò¹ÍÒ¨ÂѧäÁ‹¤Í‹ ÂࢌÒ㨪Ѵਹ¶Ö§Çѵ¶Ø»ÃÐʧ¤áÅÐ ÇÔ¸¡Õ Òû¯ÔºµÑ Ô â´Â੾ÒÐÍ‹ҧÂÔ§è ¡ÒùíÒËÅÑ¡¡Òâͧ Good Pharmacy Practice ÁÒ㪌¨ÐÁÕÊNj ¹ª‹Ç¾Ѳ¹Ò§Ò¹àÀÊѪ¡ÃÃÁ ªØÁª¹Í‹ҧäúŒÒ§ áÅФÙÁ‹ Í× GPP ¤×ÍÍÐäà ¨ÐÁÕº·ºÒ·ËÃ×Í»ÃÐ⪹Í‹ҧäõ‹ÍÌҹÂÒ «Ö§è ¨Ð¡Å‹ÒÇã¹ÅíҴѺµ‹Íä» ·Õèä»·ÕèÁҢͧËÅÑ¡¡Òà GPP (Good Pharmacy Practice) áÅСÒèѴ·íҤًÁ×Í GPP ˹‹Ç§ҹÊÁҾѹ¸ àÀÊѪ¡ÃÃÁÊÒ¡Å FIP (International Pharmaceutical Federation) áÅÐͧ¤¡ÒÃ͹ÒÁÑÂâÅ¡ WHO (World Health Organization) 䴌µÃÐ˹ѡàË繶֧¤ÇÒÁᵡµ‹Ò§´ŒÒ¹º·ºÒ·¢Í§àÀÊѪ¡Ãã¹áµ‹ÅлÃÐà·È໚¹Í‹ҧÁÒ¡ ¨Ö§ÁÕ¡ÒùíÒá¹Ç¤Ô´ ¡ÒþѲ¹ÒÇÔ¸»Õ ¯ÔºµÑ ·Ô ´Õè ·Õ Ò§àÀÊѪ¡ÃÃÁ GPP (Good Pharmacy Practice) ÁÒ໚¹¹âºÒÂà¼Âá¾Ã‹ ·Ñ§é ¹Õàé ¾×Íè ãˌ»ÃЪҪ¹Áѹè 㨠ã¹ÁҵðҹÇÔªÒªÕ¾ ¡ÒùíÒä»ÊÙ¤‹ ÇÒÁ»ÅÍ´ÀÑ áÅлÃÐ⪹Í¹×è æ â´Âãˌ¤Òí ¹Ö§¶Ö§ÊÀÒ¾¤ÇÒÁ໚¹¨ÃÔ§¢Í§áµ‹ÅлÃÐà·È Íѹ䴌ᡋ ¾×é¹°Ò¹´ŒÒ¹¡®ËÁÒ ÊÀÒ¾àÈÃÉ°¡Ô¨ Êѧ¤Á µÅÍ´¨¹ÃкººÃÔ¡ÒÃÊÒ¸ÒóÊØ¢¢Í§»ÃÐà·È¹Ñé¹æ »˜¨¨ØºÑ¹ÁÕ ËÅÒ»ÃÐà·È䴌¡íÒ˹´ÇÔ¸Õ»¯ÔºÑµÔ·Õè´Õ·Ò§àÀÊѪ¡ÃÃÁ GPP ¢Í§»ÃÐà·Èµ¹àͧänj áÅÐÁÕ¡ÒùíÒä»»¯ÔºÑµÔÍ‹ҧ¨ÃÔ§¨Ñ§ Í‹ҧ໚¹ÃÙ»¸ÃÃÁ ÊíÒËÃѺ»ÃÐà·Èä·Â䴌ÁÕ¤ÇÒÁ¾ÂÒÂÒÁ¼ÅÑ¡´Ñ¹¨Ò¡ËÅÒÂÀҤʋǹãˌ¡ÒúÃÔ¡Ò÷ҧàÀÊѪ¡ÃÃÁ¢Í§ÀÒ¤ºÃÔ¡Òà µ‹Ò§æ 䴌ºÃÃÅØÁҵðҹ GPP ´Ñ§¡Å‹ÒÇ â´Â੾ÒÐã¹Ê‹Ç¹§Ò¹àÀÊѪ¡ÃÃÁªØÁª¹Íѹ䴌ᡋ Ìҹ¢ÒÂÂÒ â´Â෋ҷռè ҋ ¹ÁÒ ä´ŒÁÕ¡ÒÃÍ͡ࡳ±ÁҵðҹÌҹÂÒâ´ÂÊÀÒàÀÊѪ¡ÃÃÁ ¡ÒÃÁÕâ¤Ã§¡ÒþѲ¹ÒÌҹÂÒãˌ໚¹ÃŒÒ¹ÂҤسÀÒ¾ µÅÍ´¨¹ ¡ÒÃà»ÅÕè¹á»Å§¡®ËÁÒµ‹Ò§æ à¾×èÍàÍ×é͵‹Í¡Òû¯ÔºÑµÔµÒÁ¡Ãͺ GPP áÅмÅÑ¡´Ñ¹ãˌÌҹÂÒ໚¹Ê‹Ç¹Ë¹Ö觢ͧ Ãкº»ÃСѹÊØ¢ÀÒ¾áˋ§ªÒµÔ ᵋ㹤ÇÒÁ໚¹¨ÃÔ§ÂѧÁÕÃҌ ¹¢ÒÂÂÒ¨íҹǹÁÒ¡·ÕÂè §Ñ »¯ÔºµÑ áÔ µ¡µ‹Ò§¨Ò¡Áҵðҹ·ÕÇè Ò§änjÁÒ¡ ʋǹ˹֧è à¹×Íè §¨Ò¡¤ÇÒÁäÁ‹à¢ŒÒ㨶‹Í§á·Œã¹Áҵðҹ ·Ñ§é ÇÔ¸¡Õ ÒÃáÅСÒÃàËç¹µÑÇÍ‹ҧ·Õªè ´Ñ ਹ (ÀÔ­ØÀÒ à»ÅÕÂè ¹ºÒ§ªŒÒ§ áÅдǧ·Ô¾Â ˧ʏÊع·Ã : ¤ÇÒÁ¤Ô´àËç¹à¨ŒÒ¢Í§ÃŒÒ¹ÂÒ·ÑèÇ»ÃÐà·Èµ‹ÍÁҵðҹÌҹÂҢͧÊÀÒàÀÊѪ¡ÃÃÁ, 2006) ÃÇÁ¶Ö§ÇÔ¸¡Õ Òû¯ÔºµÑ ºÔ ҧ͋ҧÂÒ¡·Õ¨è л¯ÔºµÑ äÔ ´Œ¨ÃÔ§ (Conclusion from 19 Thai participants in the GPP workshop by Dick Tromp in Thailand, 2005) ÍÕ¡·Ñ§é ÂѧäÁ‹àËç¹»ÃÐ⪹áÅФÇÒÁÊíҤѭ ËÃ×ÍÅѧàÅ·Õ¨è Ðŧ·Ø¹ã¹¡ÒûÃѺ»Ãا ¾Ñ²¹ÒÌҹãˌࢌҡѺࡳ±·ÕèµÑé§änj ᵋ´ŒÇ¡ÒõÃÐ˹ѡ¶Ö§º·ºÒ·¢Í§ÃŒÒ¹ÂÒ·Õè¨Ð໚¹»ÃÐ⪹ã¹¡ÒáÃШÒÂÂÒ ãˌ»ÃЪҪ¹à¢ŒÒ¶Ö§ã¹¡ÒôÙáÅÊØ¢ÀÒ¾àº×éͧµŒ¹ (Primary health care) ËÒ¡ÁÕ¡Òúѧ¤ÑºãªŒ¡®à¡³±Í‹ҧã´Í‹ҧ˹Öè§ â´ÂäÁ‹ÃѺ¤ÇÒÁËÇÁÁ×Í ÂÔ¹ÂÍÁ¾ÃŒÍÁ㨠¨Ð໚¹¡ÒÃÊÌҧ»˜­ËÒãˌà¡Ô´¢Öé¹µÒÁÁÒ ´Ñ§¹Ñ鹡ÒÃÊÌҧ¤ÇÒÁࢌÒã¨áÅШ٧㨠ãˌËÇÁÁ×ͨÐ໚¹á¹Ç·Ò§·ÕèàËÁÒÐÊÁ ´ŒÇ¡ÒÃàÅç§àË繤ÇÒÁÊíҤѭ¢Í§»˜­ËÒàËŋҹÕé ËÅÒÂͧ¤¡Ã·Ñé§ÀÒ¤ÃÑ°áÅÐàÍ¡ª¹ 䴌ᡋ Êíҹѡ¾Ñ²¹ÒÌҹÂÒ ÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹áˋ§»ÃÐà·Èä·Â ÊÁҾѹ¸¾Ñ²¹ÒÌҹÂҤسÀÒ¾ áÅÐÀҤʋǹ ¨Ò¡Ê¶ÒºÑ¹¡ÒÃÈÖ¡ÉÒ¨Ö§àËç¹¾ŒÍ§¡Ñ¹Ç‹Ò¤ÇÃÁÕà¤Ã×Íè §Á×Í·Õ¨è Ъ‹Ç¼ٻŒ ¯ÔºµÑ §Ô ҹ䴌ࢌÒã¨Çѵ¶Ø»ÃÐʧ¤áÅÐá¹Ç·Ò§ã¹¡Òû¯ÔºµÑ Ô µÒÁÇÔ¸Õ»¯ÔºÑµÔ·Õè´Õ·Ò§àÀÊѪ¡ÃÃÁªØÁª¹à¾×èÍÊÒÁÒö¹íÒÁÒ㪌»¯ÔºÑµÔ䴌Í‹ҧ¨ÃÔ§¨Ñ§ 20


͹Öè§ã¹»˜¨¨ØºÑ¹ÇÔ¸Õ»¯ÔºÑµÔ·Õè´Õ·Ò§àÀÊѪ¡ÃÃÁ (GPP) ã¹Ê‹Ç¹¢Í§àÀÊѪ¡ÃÃÁªØÁª¹ÂѧäÁ‹ä´Œ¡íÒ˹´¢Öé¹ÁÒ੾ÒРᵋÍÒÈѺÃÔº·¢Í§à¡³±ÁҵðҹÌҹÂÒ·ÕèÍÍ¡â´ÂÊÀÒàÀÊѪ¡ÃÃÁ໚¹ËÅѡ仡‹Í¹â´Â»ÃÐÊÒ¹ãˌÊÍ´¤ÅŒÍ§¡Ñº ¢ŒÍ¡íÒ˹´µ‹Ò§æ ·Õ¨è лÃСÒÈ㪌䴌ᡋ ¢ŒÍºÑ§¤ÑºÊÀÒÏ Ç‹Ò´ŒÇ¢ŒÍ¨íÒ¡Ñ´áÅÐà§×Íè ¹ä¢ã¹¡ÒûÃСͺÇÔªÒªÕ¾àÀÊѪ¡ÃÃÁªØÁª¹ »ÃСÒÈ¡®¡ÃзÃǧµ‹Ò§æ ¾.Ã.º. ¤ÇÒÁÃѺ¼Ô´µ‹ÍÊÔ¹¤ŒÒ·Õäè Á‹»ÅÍ´ÀÑ (PL law) ໚¹µŒ¹ ´Ñ§¹Ñ¹é ã¹Ê‹Ç¹¤ÙÁ‹ Í× GPP ·Õ¨è ´Ñ ·íÒ¢Ö¹é ÍÒ¨¨Ð¡Å‹ÒÇ䴌Çҋ ໚¹¡ÒùíÒÁҵðҹÌҹÂÒ«Ö§è »ÃСͺ´ŒÇÂÁҵðҹ 5 ¢ŒÍ 䴌ᡋ Áҵðҹ·Õè 1 ʶҹ·Õè ÍØ»¡Ã³ áÅÐÊÔè§Ê¹ÑºÊ¹Ø¹ºÃÔ¡Òà Áҵðҹ·Õè 2 ¡ÒúÃÔËÒèѴ¡ÒÃà¾×èͤسÀÒ¾ Áҵðҹ·Õè 3 ¡ÒúÃÔ¡ÒÃàÀÊѪ¡ÃÃÁ·Õè´Õ Áҵðҹ·Õè 4 ¡Òû¯ÔºµÑ µÔ ÒÁ¡® ÃÐàºÕº áÅШÃÔ¸ÃÃÁ Áҵðҹ·Õè 5 ¡ÒÃãˌºÃÔ¡ÒÃáÅСÒÃÁÕʋǹËÇÁ㹪ØÁª¹áÅÐÊѧ¤Á ¹íÒÁÒ¢ÂÒ¤ÇÒÁãˌࢌÒã¨ã¹à¹×Íé ËÒ ¤ÇÒÁÊíҤѭ ÇÔ¸¡Õ Òà ÃÇÁ¶Ö§ÁÕµÇÑ Í‹ҧ à¾×Íè »š¹á¹Ç·Ò§ã¹¡Òû¯ÔºµÑ §Ô ҹ䴌¨ÃÔ§ ¹Í¡¨Ò¡¹ÕÂé §Ñ ÁÕáËŋ§¤Œ¹¤ÇŒÒËÒ¤ÇÒÁÃÙàŒ ¾ÔÁè àµÔÁ´ŒÇµ¹àͧ ઋ¹ ˹ѧÊ×Í ¡ÒÃËÒ¢ŒÍÁÙÅ·Ò§ÍÔ¹àµÍÏà¹çµ à¾×Íè à¾ÔÁè ¾Ù¹¤ÇÒÁÃÙጠÅÐ àÊÃÔÁÊÁÃö¹Ð㹡Ò÷íÒ§Ò¹ (improve competency) ¢Ñé ¹ µÍ¹¡ÒÃ¨Ñ ´ ·í Ò ¤Ù‹ Á× Í GPP

Çѵ¶Ø»ÃÐʧ¤¢Í§¤ÙÁ‹ Í× GPP

à¾×Íè à¾ÔÁè ¡ÒÃÊ×Íè ÊÒÃãˌà¡Ô´¤ÇÒÁªÑ´à¨¹áÅÐࢌÒã¨ã¹»ÃѪ­Ò á¹Ç¤Ô´¢Í§ÇÔ¸»Õ ¯ÔºµÑ ·Ô ´Õè ·Õ Ò§àÀÊѪ¡ÃÃÁã¹ÃŒÒ¹ÂÒ à¾×Íè ÊÌҧ¡ÒÃÁÕÊNj ¹Ã‹ÇÁáÅСÒÃÂÍÁÃѺÇÔ¸¡Õ Ò÷մè ãÕ ¹¡ÒúÃÔ¡ÒÃàÀÊѪ¡ÃÃÁªØÁª¹ Good Pharmacy Practice : GPP ® à¾×èͨѴ·íÒ “á¹Ç·Ò§” Guideline ·ÕèࢌÒã¨ä´Œ§‹Ò ÊÒÁÒö¹íÒä»»ÃÐÂØ¡µãªŒã¹ÃŒÒ¹ÂҢͧµ¹ ¾ÃŒÍÁ·Ñé§ µÑÇÍ‹ҧ·Õªè ´Ñ ਹ ® ¨Ñ´·íÒÊÔ§è ÍíҹǤÇÒÁÊдǡ㹡ÒùíÒä»»¯Ôºµ Ñ Ô àª‹¹ µÑÇÍ‹ҧẺ¿ÍÏÁµ‹Ò§æ ÃÙ»ÀÒ¾ µÒÃÒ§ ÏÅÏ ®

21


®

ʋ§àÊÃÔÁ¡Ò䌹¤ÇŒÒËÒ¤ÇÒÁÃÙàŒ ¾ÔÁè àµÔÁ´ŒÇµ¹àͧ à¾×Íè à¾ÔÁè ÊÁÃö¹Ð㹡Ò÷íÒ§Ò¹ (improve competency)

¼Å»ÃÐ⪹·Õè¨Ðà¡Ô´¢Öé¹ËÒ¡»¯ÔºÑµÔµÒÁá¹Ç¤Ù‹Á×Í¡ÒþѲ¹Òµ¹àͧÊً¡ÒÃÁÕÇÔ¸Õ»¯ÔºÑµÔ·Õè´Õ·Ò§àÀÊѪ¡ÃÃÁ ã¹ÃŒÒ¹ÂÒ ä´Œá¡‹

1 . àÀÊѪ¡ÃªØÁª¹ÊÒÁÒö¾Ñ²¹Òµ¹àͧÊÙ¤‹ ÇÒÁ໚¹Áҵðҹ·ÕÊè §Ù ¢Ö¹é ʋ§àÊÃÔÁ¡ÒþѲ¹ÒÌҹÂÒã¹Ç§¡ÇŒÒ§ 2 . ¼ÙºŒ ÃÔâÀ¤¨Ð䴌»ÃÐ⪹áÅÐàË繤س¤‹Ò¢Í§àÀÊѪ¡ÃªØÁª¹ÁÒ¡¢Ö¹é ÊÒÁÒöµÑ´ÊÔ¹ã¨àÅ×͡ÌҹÂÒ·ÕÁè ¤Õ ³ Ø ÀÒ¾ ¡ÒÃãˌºÃÔ¡ÒÃÁÒ¡¡Ç‹Ò¾Ô¨ÒóÒᵋ´ŒÒ¹ÃÒ¤Ò ·íÒãˌÌҹàÀÊѪ¡ÃÃÁªØÁª¹·ÕèÁÕ¤ÇÒÁµÑé§ã¨»¯ÔºÑµÔ§Ò¹ä´ŒÃѺ¤ÇÒÁÈÃÑ·¸Ò ¨Ò¡»ÃЪҪ¹ áÅÐ䴌ÃѺ¤‹ÒµÍºá·¹¤ØŒÁ¤‹Ò¡Ñº·Õèŧ·Ø¹ä» 3 . ËÒ¡¤ÙÁ‹ Í× Ï GPP ໚¹·ÕÂè ÍÁÃѺ ¨Ð໚¹á¹Ç·Ò§ã¹¡ÒþѲ¹Ò¤ÙÁ‹ Í× Í×¹è æ ·Õàè »š¹»ÃÐ⪹ã¹¡ÒáÃдѺÁҵðҹ §Ò¹àÀÊѪ¡ÃÃÁªØÁª¹ã¹âÍ¡Òʵ‹Íæ ä»

á¹Çà¹×Íé ËҢͧ¤ÙÁ‹ Í× GPP »ÃСͺ´ŒÇ ® ® ® ® ® ® ® ®

¤ÇÒÁËÁÒÂáÅФÇÒÁÊíҤѭ¢Í§à¹×éÍËÒ à˵Øã´µŒÍ§»¯ÔºÑµÔµÒÁ á¹Ç·Ò§¡Òû¯ÔºµÑ µÔ ÒÁã¹ GPP ᵋÅÐËÑÇ¢ŒÍ µÑÇÍ‹ҧઋ¹ ÃÙ»ÀÒ¾ chart µÒÃÒ§ »ÃСͺ¤íÒ͸ԺÒ ËÒ¡»¯ÔºµÑ µÔ ÒÁ ¨Ð䴌»ÃÐ⪹ËÃ×ÍÁռšÃзºÍ‹ҧäà ËÒ¡äÁ‹»¯ÔºµÑ µÔ ÒÁ ¨Ðʋ§¼Å¡ÃзºËÃ×ͼÅàÊÕÂÍ‹ҧäõ‹ÍÌҹÂÒËÃ×͵‹Í¼ÙÌ ºÑ ºÃÔ¡Òà µÑǪÕéÇÑ´¼ÅÊÑÁÄ·¸Ôì¤×ÍÍÐäà áËŋ§¡ÒÃËÒ¤ÇÒÁÃÙàŒ ¾ÔÁè àµÔÁ ઋ¹ ˹ѧÊ×Í ·Ò§ internet

µÑÇÍ‹ҧà¹×éÍËÒ㹤ًÁ×Í GPP ¢Í¡µÑÇÍ‹ҧËÑÇ¢ŒÍ·Õèã¹ÃŒÒ¹ÂÒÍÒ¨¾ºº‹ÍÂâ´Â·ÕèàÃÒÍÒ¨äÁ‹ä´Œãˌ¤ÇÒÁÊíҤѭ ෋ҷդè Çà ઋ¹ 22


ËÑ Ç ¢Œ Í 2.2.4 ÁÕ ¡ ÒÃÇÔ à ¤ÃÒÐˏ á ÅÐÃÐºØ ¤ ÇÒÁàÊÕè  §·Õè Í Ò¨à¡Ô ´ ¢Öé ¹ ¾ÃŒ Í Á·Ñé § á¹Ç·Ò§¡ÒúÃÔ Ë ÒÃ¨Ñ ´ ¡Òà ·Õè à »š ¹ ÃÙ » ¸ÃÃÁ ઋ ¹ ¤ÇÒÁ»ÅÍ´ÀÑ Â ¢Í§¡ÒÃãˌ º ÃÔ ¡ Òà ¡Òè‹ Ò ÂÂÒ¼Ô ´ ໚ ¹ µŒ ¹ 1 . ¤ÇÃÁÕÃкºà½‡ÒÃÐÇѧ¤ÇÒÁ¼Ô´¾ÅÒ´ 䴌ᡋ 1.1 ¤ÇÒÁ¼Ô´¾ÅÒ´ÍÒ¨à¡Ô´¢Ö¹é 䴌 ÁÕ¤ÇÒÁàÊÕÂè § 1.2 ¤ÇÒÁ¼Ô´¾ÅÒ´à¡×ͺ¨Ðà¡Ô´¢Öé¹áµ‹á¡Œä¢·Ñ¹ 1.3 ¤ÇÒÁ¼Ô´¾ÅÒ´à¡Ô´¢Öé¹áÅŒÇ 2 . ÁÕ¡ÒÃÇÔà¤ÃÒÐˏÊÒà˵آͧ¤ÇÒÁ¼Ô´¾ÅÒ´·Õèà¡Ô´¢Öé¹ áÅмŢͧ¤ÇÒÁ¼Ô´¾ÅÒ´µ‹Ò§æ 3 . ¨Ñ´ãˌÁÕá¹Ç·Ò§ã¹¡Òû‡Í§¡Ñ¹¤ÇÒÁ¼Ô´¾ÅÒ´ 4 . ÁÕ¡ÒõÃǨÇÑ´¼Å¢Í§¡Òû¯ÔºÑµÔµÒÁá¼¹¡ÒÃàËŋҹÑé¹ µÑÇÍ‹ҧ¢Í§¤ÇÒÁ¼Ô´¾ÅÒ´·Õèà¤Âà¡Ô´¢Ö鹨ÃÔ§ã¹ÃŒÒ¹ÂÒáÅÐá¹Ç·Ò§á¡Œä¢ 4.1 ã¹¡Ã³Õ ¨‹ Ò ÂÂÒÍÑ ¹ µÃÒÂâ´ÂäÁ‹ · ÃÒºÅÑ ¡ ɳТͧ¼ÙŒ ã ªŒ ÁÕ â Í¡ÒÊà¡Ô ´ ÍÑ ¹ µÃÒÂ䴌 4.1.1 ¡Ã³Õ¨Ò‹ ÂÂҫͧᡌ䢌ËÇÑ´â´ÂäÁ‹Êͺ¶ÒÁ 㹡óÕ໚¹¼Ùʌ §Ù ÇѤÇÃÃÐÇѧàÃ×Íè §âä»ÃШíÒ·Õàè »š¹ÍÂً 䴌ᡋ àºÒËÇÒ¹ ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ âäËÑÇ㨠µ‹ÍÁÅÙ¡ËÁÒ¡âµ 4.1.2 ¡Ã³Õ¨Ò‹ ÂÂÒ·ÕÁè ÄÕ ·¸Ô·ì Òí ãˌ§Ç‹ §«ÖÁâ´ÂäÁ‹·ÃҺNjҼÙ㌠ªŒÁÍÕ ÒªÕ¾·Õ§è Nj §äÁ‹ä´Œ ઋ¹ µŒÍ§¢ÑºÃ¶ ·íÒ§Ò¹¡Ñº à¤Ã×Íè §¨Ñ¡Ã ໚¹µŒ¹ 4.1.3 ¨‹ÒÂÂÒ·ÕÃè ФÒÂà¤×ͧ㹡ÃÐà¾ÒÐ㹡óշ¼Õè »ÙŒ dž ÂÍÒ¨ÊÙ§ÇÑ ËÃ×ÍÁÕ¤ÇÒÁàÊÕÂè §ÊÙ§µ‹Íâäá¼Å㹡ÃÐà¾ÒÐ áÅÐÅíÒäʌ 4.1.4 ¡Òè‹ÒÂÂÒãˌ¼ÙŒË­Ô§·Õè»ÃШíÒà´×͹¢Ò´¤ÇäíÒ¹Ö§´ŒÇÂNjÒÍÒ¨ÁÕ¡ÒõÑ駤ÃÃÀËÃ×ÍäÁ‹ 4.1.5 ¡Òè‹ÒÂÂÒãˌà´ç¡àÅç¡â´ÂäÁ‹·ÃÒº¹éÒí ˹ѡµÑÇÁÕâÍ¡Òʤíҹdz¢¹Ò´¼Ô´¾ÅÒ´ «Ö§è ÍÒ¨ÁÕ¼ÅàÊÕÂ·Ñ§é ¡ÒÃ䴌 ÃѺÂÒ¹ŒÍÂËÃ×ÍÁÒ¡à¡Ô¹ä» 4.2 ¡Òëéí Ò «Œ Í ¹ 4.2.1 ¨‹ÒÂÂÒãˌ¼»ÙŒ dž ·Õäè ´ŒÃºÑ ÂÒ¨Ò¡·ÕÍè ¹×è ÁÒ¡‹Í¹«Ö§è ÍÒ¨à¡Ô´¡ÒëéÒí «ŒÍ¹ ઋ¹ ¡ÒÃä´ŒÃºÑ ÂÒᡌ»Ç´Å´ä¢Œ«Òéí ¡Ñ¹ ¡ÒÃ䴌ÃѺÂÒ·ÕèÁÕÄ·¸Ôì¡´Ãкº»ÃÐÊҷʋǹ¡ÅÒ§àËÁ×͹¡Ñ¹ 4.2.2 ÂÒ·ÕÁè »Õ ¯Ô¡ÃÔ ÂÔ Òµ‹Í¡Ñ¹ ઋ¹ 㹡óշ¼Õè »ÙŒ dž Âᨌ§Ç‹Ò໚¹âäËÑÇ㨤ÇöÒÁãˌṋª´Ñ NjÒ໚¹âäËÑÇã¨Í‹ҧäÃ ä´ŒÃºÑ ¡ÒÃÃÑ¡ÉÒÍÐäÃÁÒºŒÒ§ ÁÕ¡Òü‹ÒµÑ´ãʋ¢´ÅÇ´ËÃ×Í·íÒ bypass ÁÒËÃ×ÍäÁ‹ ä´ŒÃºÑ ÂÒ warfarin ËÃ×Í aspirin ËÃ×ÍäÁ‹ 4.2.3 ¡Ã³ÕÂÒà´ç¡ ÂÒ¹éÒí ÁÑ¡ÁÕÊNj ¹¼ÊÁËÅÒµÑÇ âÍ¡ÒÊä´ŒÃºÑ ÂÒºÒ§µÑÇà¡Ô¹¢¹Ò´à¡Ô´¢Ö¹é 䴌ºÍ‹ Âæ 5. ¡Òè‹ÒÂÂÒâ´ÂäÁ‹·ÃÒºÍÒ¡Ò÷Õè᷌¨ÃÔ§ 5.1 㹡Òè‹ÒÂÂÒᡌ䢌¤Ç÷ըè Ð䴌Á¡Õ ÒÃÇѴ䢌à¾×Íè ãˌ·ÃҺṋª´Ñ NjÒÁÕ䢌¨ÃÔ§ËÃ×ÍäÁ‹ ¤ÇÃÁÕ¡Ò贺ѹ·Ö¡änj໚¹ ËÅÑ¡°Ò¹ à¾ÃÒÐ㹺ҧ¡Ã³ÕÍÒ¨ÁÕ¡ÒÃÇÑ´«éÒí ÍÕ¡ã¹Çѹµ‹Íæ ÁÒ 5.2 㹡óըҋ ÂÂÒᡌ»Ç´ËÑÇãˌ¼ãٌ Ë­‹ ¶ŒÒ໚¹ä»ä´Œ¤ÇèÐ䴌Á¡Õ ÒÃÇѴ䢌áÅÐÇÑ´¤ÇÒÁ´Ñ¹âÅËÔµàÊÁÍ à¾×Íè ໚¹¡Òà á¡ÀÒÇе‹Ò§æ ÍÍ¡¨Ò¡¡Ñ¹ä´Œª´Ñ ਹ ÃÐËNjҧÍÒ¡ÒûǴËÑǨҡ䢌 ¨Ò¡âäµÔ´àª×Íé ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ ËÃ×ͤÇÒÁà¤ÃÕ´ 5.3 ¡Òýҡãˌ¼Íٌ ¹×è ÁÒ«×Íé ÂÒá·¹ ÁÕâÍ¡ÒÊ䴌¢ÍŒ ÁÙÅ·Õáè ·Œ¨ÃÔ§¼Ô´¾ÅҴ䴌àÊÁÍ àª‹¹ ¼Ù»Œ dž ½ҡÁÒ«×Íé ÂÒᡌ»Ç´ËÑÇ ÍÒ¨à¡Ô´¨Ò¡ÀÒÇФÇÒÁ´Ñ¹âÅËÔµÊÙ§¢Ñé¹ÃŒÒÂá稹µŒÍ§¹íÒʋ§µ‹Íâ´Â´‹Ç¹ ¶ŒÒ໚¹ä»ä´Œ¤ÇÃËҷҧ䴌¾Ù´¤Ø ¡Ñº¼Ù»Œ dž Ââ´ÂµÃ§ ÍҨ㪌â·ÃÈѾ·à»š¹µŒ¹ ËÃ×Í㹡óÕàÁ×Íè ¿˜§ÍÒ¡ÒÃáŌǹ‹ÒʧÊÑ ¡Òû¯ÔàʸäÁ‹¨Ò‹ ÂÂÒãˌ¼»ÙŒ dž  ÍÒ¨´Õ¡Ç‹Ò¡Òè‹ÒÂÂÒä»´ŒÇ«éÒí ¤ÇèѴ·íÒàÍ¡ÊÒ÷Õáè ¨Œ§¢ŒÍÁÙÅâ´ÂµÃ§¡Ñº¼Ù㌠ªŒÂÒ੾ÒÐÃÒÂà¾×Íè ªÕáé ¨§ãˌà¡Ô´ ¤ÇÒÁ¡ÃШ‹Ò§ªÑ´áÅÐ˹ѡṋ¹ 23


5.4 ¡Ò÷ÕÁè Ңͫ×Íé ÂÒ»¯ÔªÇÕ ¹Ðä»à¾×Íè ºíҺѴÍÒ¡Ò÷Õäè Á‹ä´ŒÁ¤Õ ÇÒÁ¨íÒ໚¹µŒÍ§ãªŒÂÒ¹Ñ¹é ¤ÇèѴ·íÒÊ×Íè ¹íÒàʹÍãˌ ¢ŒÍÁÙÅà¾×Íè ¡ÒÃà»ÅÕÂè ¹á»Å§¤ÇÒÁ¤Ô´ ઋ¹ ¡ÒèѴËÒÃÙ»¢Í§¡ÒÃà¨çº¤Í·Õäè Á‹ä´Œà¡Ô´¨Ò¡¡ÒõԴàª×Íé bacteria ¨Ö§äÁ‹¨Òí ໚¹µŒÍ§ãªŒÂÒ»¯ÔªÇÕ ¹Ð ໚¹µŒ¹

ÃٻẺ¡ÒÃáÊ´§¤ÇÒÁ¤Ô´àË繢ͧÊÁÒªÔ¡àÀÊѪ¡ÃÃÁªØÁª¹µ‹Í¤Ù‹Á×Í GPP

¡ÒèѴ·íҤًÁ×Í GPP ÊíÒËÃѺÌҹÂÒ¤ÃÑ駹Õé໚¹á¤‹¨Ø´àÃÔèÁµŒ¹ ÍÒ¨äÁ‹ÊÁºÙóáºº¤Ãº¶ŒÇ¹ ÂѧÁÕËÅÒÂæ ʋǹ·Õè¨ÐµŒÍ§¡Ò÷º·Ç¹ à¾ÔèÁàµÔÁ ãˌ¤Ãͺ¤ÅØÁáÅзѹÊÁÑ àÃÒµŒÍ§¡ÒäÇÒÁËÇÁÁ×ÍËÇÁ㨨ҡà¾×è͹àÀÊѪ¡ÃªØÁª¹ ʹѺʹعãˌÁ¡Õ ÒþѲ¹Òµ‹Íä»àÃ×Íè Âæ ´Ñ§¹Ñ鹡ÒÃÃѺ¿˜§¢ŒÍàʹÍá¹ÐáÅФÇÒÁ¤Ô´àË繨ҡà¾×è͹ÊÁÒªÔ¡àÀÊѪ¡ÃÃÁªØÁª¹¨ÐÁÕʋǹª‹ÇÂãˌÊÒÁÒö ¹íÒä»»ÃѺ»Ãاᡌ䢤ÙÁ‹ Í× GPP ãˌÁ¤Õ ÇÒÁÊÁºÙóÁÒ¡ÂÔ§è ¢Ö¹é ¤³Ð¼Ù¨Œ ´Ñ ·íÒ¤ÙÁ‹ Í× ¨Ö§¢ÍàªÔ­ªÇ¹ÊÁÒªÔ¡Ï ä´ŒÁÊÕ Ç‹ ¹Ã‹ÇÁáÊ´§ ¤ÇÒÁ¤Ô´àËç¹µ‹Í¤ÙÁ‹ Í× Ï â´Â·‹Ò¹ÊÒÁÒöÈÖ¡ÉÒËҧ¤ÙÁ‹ Í× GPP 䴌·Ò§àÇçºä«µÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹ ·Õè www.pharcpa.com áÅÐÊÒÁÒöáÊ´§¤ÇÒÁ¤Ô ´ àËç ¹ 䴌 Í Â‹ Ò §à» ´ ¡ÇŒ Ò § ¡µÑ Ç Í‹ Ò §àª‹ ¹ ¤ÇÒÁ¤Ô ´ àËç ¹ µ‹ Í ¤ÇÒÁàËÁÒÐÊÁ¢Í§à¹×é Í ËÒ ¤ÇÒÁÂÒ¡§‹Òµ‹Í¡Ò÷íÒ¤ÇÒÁࢌÒ㨠¡Ã³Õ·ÃÕè Êٌ ¡Ö Njһ¯ÔºµÑ äÔ ´ŒÂÒ¡¡çÍÒ¨áÅ¡à»ÅÕÂè ¹àÃÕ¹ÃÙàŒ ¾×Íè ËÒ˹·Ò§á¡Œä¢Ã‹ÇÁ¡Ñ¹ ÊÔ§è Í×¹è æ ·ÕèÍÂÒ¡ãˌºÃèØã¹à¹×éÍËÒà¾ÔèÁàµÔÁà¾×è͹íÒÁÒª‹ÇÂᡌ»˜­ËÒ·Õ跋ҹ»ÃÐʺÍÂً ËÃ×ÍÊÔ觷Õ跋ҹ䴌»¯ÔºÑµÔáÅлÃÐʺ¼ÅÊíÒàÃç¨ ã¹¡ÒÃᡌ»­ ˜ ËÒáÅÐÍÂÒ¡¹íÒä»à¼Âá¾Ã‹ãˌà¾×Íè ¹ÊÁÒªÔ¡·ÃÒº ËÃ×Íãˌ¤ÇÒÁàË繶֧¤ÇÒÁ໚¹ä»ä´Œã¹¡ÒùíÒä»»¯ÔºµÑ Ô â´ÂàÊ¹Í ã¹ÃÙ»¢Í§¡Ô¨¡ÃÃÁà¾×Íè ãˌÊÁÒªÔ¡·‹Ò¹Í×¹è ¹íÒ仵‹ÍÂʹ䴌

º·ÊÃØ»¢Í§¡ÒùíÒ¤ÙÁ‹ Í× GPP ä»ãªŒã¹ÃŒÒ¹ÂÒ

¤ÙÁ‹ Í× GPP äÁ‹ãª‹¤ÁÑ ÀÕÃà ·Ç´Ò äÁ‹ãª‹à¤Ã×Íè §ÃÒ§¢Í§¢Åѧ ᵋÍҨ໚¹à¤Ã×Íè §Á×ͪ‹ÇÂá¹Ðá¹Ç·Ò§à¾×Íè ¤ÇÒÁÍÂÙË Í´ ã¹ÀÒÇзÕÁè ¡Õ ÒÃᢋ§¢Ñ¹Ê٧㹻˜¨¨Øº¹Ñ ËÒ¡àÃÒäÁ‹»ÃѺµÑÇâ´ÂÂѧà¤ÂªÔ¹¡Ñº¡Ò÷íҧҹẺà´ÔÁæ ‹ÍÁäÁ‹ä´ŒÊÌҧ¤ÇÒÁᵡµ‹Ò§ áÅÐÊÌҧ¤Ø³¤‹Òãˌà¡Ô´¡ÑºÇÔªÒªÕ¾áÅлÃЪҪ¹ä´Œà·‹Ò·Õ¤è Çà ´Ñ§¹Ñ¹é ¡ÒÃÈÖ¡ÉÒáÅÐÅͧ»¯ÔºµÑ µÔ ÒÁ¤ÙÁ‹ Í× Ï ÊíÒËÃѺ¼Ù·Œ àÕè ÃÔÁè µŒ¹ãËÁ‹ â´Â¤‹ÍÂæ »ÃѺ»Ãا¡Ò÷íÒ§Ò¹¡ç¨Ð¾Ñ²¹ÒÌҹàÀÊѪ¡ÃÃÁªØÁª¹ãˌ¡ÒŒ Ç˹ŒÒ䴌 ÊíÒËÃѺ¤¹·Õ»è ¯ÔºµÑ §Ô Ò¹ÁÒ¹Ò¹áŌǺҧ¤Ãѧé ÍÒ¨ ÁÕ¤ÇÒÁà¤ÂªÔ¹ªÒ¨¹Å×Áä»Ç‹Òá¹Ç»¯ÔºµÑ ·Ô ´Õè ¹Õ ¹Ñé ໚¹Í‹ҧäà ¡çÊÒÁÒö㪌¤Áً Í× ¹Õàé »š¹á¹Ç·Ò§ã¹¡Ò÷º·Ç¹à¾×Íè ¾Ñ²¹Òµ‹Í ¤ÙÁ‹ Í× GPP ·Õ¨è ´Ñ ·íÒ¹Õ¨é ÐÁÕ»ÃÐ⪹äÁ‹ÁÒ¡¡ç¹ÍŒ Âà¾Õ§㴠¡ç¢¹Öé ÍÂÙ¡‹ ºÑ ¾Ç¡·‹Ò¹àͧ㹡ÒõѴÊÔ¹ã¨Å§Á×Í Å§áç Á؋§ÁÑè¹·íÒ§Ò¹ ÁÔ㪋»ÃÐ⪹áµ‹µÑÇ·‹Ò¹àͧà¾Õ§Í‹ҧà´ÕÂÇᵋà¾×è;Ѳ¹ÒÇÔªÒªÕ¾àÀÊѪ¡ÃÃÁªØÁª¹áÅÐà¾×èÍ»ÃÐ⪹ÊØ¢ ᡋ»ÃЪҪ¹

24


º·¤ÇÒÁ¾ÔàÈÉ

à¹×Íè §¨Ò¡¢³Ð¹Õ·é Ò§¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ (ÍÂ.) ÁÕ¤ÇÒÁࢌÁ§Ç´ ໚ ¹ Í‹ Ò §Áҡ㹡ÒäǺ¤Ø Á ¡Òèí Ò Ë¹‹ Ò ÂÂÒ ãˌ à »š ¹ 仵ÒÁ¡®ËÁÒ â´Â੾ÒÐÍ‹ҧÂÔè§ÂÒ·ÕèÁÕÊٵüÊÁ Pseudoephedrine áÅÐÂҤǺ¤ØÁ¾ÔàÈÉ â´Â੾ÒСÅ؋ Á ÂÒÊàµÕ  ÃÍ´ (Steroid) â´Â¤Çº¤Ø Á µÑé § ᵋ º ÃÔ ÉÑ · ¼ÙŒ ¼ ÅÔ µ ¼ÙŒ¨Ñ´¨íÒ˹‹Ò«Ö觨еŒÍ§¢ÒÂãˌ¡Ñºâç¾ÂÒºÒÅ ¤ÅÔ¹Ô¡ áÅÐÌҹ¢ÒÂÂÒ·ÕèÁÕãº Í¹Ø ­ Òµ¶Ù ¡ µŒ Í § â´Â੾ÒÐÌ Ò ¹¢ÒÂÂÒµŒ Í §à»š ¹ Ì Ò ¹¢ÒÂÂÒá¼¹»˜ ¨ ¨Ø ºÑ ¹ ·Õè ÁÕ ãºÍ¹Ø ­ Òµ¢ÒÂÂÒá¼¹»˜ ¨ ¨Ø ºÑ ¹ ෋ Ò ¹Ñé ¹ ·Ñ§é ¹Õ¤é ³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ (ÍÂ.) 䴌µÃǨÊͺ¢ŒÍÁÙÅ¡ÒâÒÂÂÒ¨Ò¡ ºÃÔÉÑ·¼ÙŒ¼ÅÔµáÅмٌ¨Ñ´¨íÒ˹‹Ò¾ºÇ‹ÒÂѧÁÕ¡ÒâÒÂÂÒãˌ¡ÑºÊ¶Ò¹·Õè·ÕèäÁ‹ÁÕÍÂً¨ÃÔ§ ·ÕèÍÂًäÁ‹µÃ§¡Ñº¢ŒÍÁÙÅã¹ãºÍ¹Ø­Òµ ¢ÒÂãˌ¡Ñºª×èͺؤ¤Å·ÑèÇä» ¢Ò¨íҹǹÁÒ¡ ãˌ¡ÑºÊ¶Ò¹·Õè·ÕèäÁ‹ÁÕãºÍ¹Ø­Òµ¢ÒÂÂÒá¼¹»˜¨¨ØºÑ¹ ¨íҹǹ¡ÒÃÊÑ觫×éͨÃÔ§äÁ‹µÃ§ µÒÁÃÒ§ҹ Êí Ò ¹Ñ ¡ §Ò¹¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒ ¨Ö § ¢Íãˌ ÁÕ ¡ ÒÃ์ ¹ Âéí Ò µ‹ Í ºÃÔ ÉÑ · ¼ÙŒ ¼ ÅÔ µ áÅкÃÔ ÉÑ · ¼ÙŒ ¨Ñ ´ ¨í Ò Ë¹‹ Ò Âãˌ à ¾Ôè Á ¤ÇÒÁÃÐÁÑ ´ ÃÐÇÑ § 㹡ÒâÒÂÂÒ ãˌ໚¹ä»µÒÁ¡®ËÁÒ à¾×Íè »‡Í§¡Ñ¹¡ÒùíÒÂÒä»ãªŒã¹·Ò§·Õ¼è ´Ô â´Â੾ÒÐÍ‹ҧÂÔ§è ÂÒ·ÕèÁÕÊٵüÊÁ Pseudoephedrine áÅÐÂҤǺ¤ØÁ¾ÔàÈÉâ´Â੾ÒСÅ؋ÁÂÒ ÊàµÕÂÃÍ´ (Steroid) ¾ÃŒÍÁ·Ñé§à¹Œ¹ÂéíÒ¡ÒèѴ·íÒÃÒ§ҹàʹ͵‹ÍÊíҹѡ§Ò¹ ¤³Ð¡ÃÃÁ¡ÒÃÍÒËÒÃáÅÐÂÒãˌ à »š ¹ ä»Í‹ Ò §¶Ù ¡ µŒ Í § (â´Â੾ÒÐ àÃ×è Í §·Õè Í Âً ¢ ͧÌ Ò ¹ÂÒ) ËÒ¡ÃÒ§ҹäÁ‹ ¶Ù ¡ µŒ Í § àÀÊÑ ª ¡Ã¼ÙŒ ÁÕ Ë ¹Œ Ò ·Õè » ¯Ô ºÑ µÔ ¡ Òà ¨Ð¶Ù ¡ ÁÕ â ·É»ÃÑ º áÅÐÍÒ¨¨ÐÁÕ â ·Éã¹´Œ Ò ¹¨ÃÃÂÒºÃóÇÔ ª ÒªÕ ¾ Ë Ç Á´Œ Ç Â ¨Ö § ã¤Ã‹ ¢ ͤÇÒÁË Ç ÁÁ× Í ¨Ò¡·‹ Ò ¹ÊÁÒªÔ ¡ Ì Ò ¹¢ÒÂÂÒ ´Ñ § ¹Õé 1 . ËÒ¡¢Œ Í ÁÙ Å ·Õè µÑé § ¢Í§ÃŒ Ò ¹¢ÒÂÂÒ µÒÁ·ÐàºÕ  ¹ÃÒɮÏ 㺷ÐàºÕ  ¹¾Ò³Ô ª  äÁ‹ µ ç¡Ñ º ·Õè µÑé § ã¹ãºÍ¹Ø ­ Òµ¢ÒÂÂÒ ã¹ÃÐËNj Ò §¡Òà µ‹ Í ÍÒÂØ ã ºÍ¹Ø ­ Òµ¢ÒÂÂÒá¼¹»˜ ¨ ¨Ø ºÑ ¹ »ÃШí Ò »‚ ãˌ ª‹ Ç Âᡌ ä ¢¡Ñ º ·Ò§ ÍÂ. ´Œ Ç ÂËÃ× Í â´Â´‹ Ç ¹·Õè ÊØ ´ à¾ÃÒÐâ´ÂËÅÑ ¡ ¡ÒÃáŌ Ç ¢Œ Í ÁÙ Å ·Õè Í Âً ¢ ͧ·Ñé § 3 ʋ Ç ¹ µŒ Í §µÃ§¡Ñ ¹ 2. ËÒ¡ÁÕ ¡ ÒÃᡌ ä ¢¡ÃØ ³ Òãˌ ¢Œ Í Á٠Šᡋ º ÃÔ ÉÑ · ¼ÙŒ ¼ ÅÔ µ áÅÐ ¼ÙŒ ¨Ñ ´ ¨í Ò Ë¹‹ Ò Â à¾×è Í ¹í Ò ä»»ÃÑ º »ÃØ § °Ò¹¢Œ Í Á٠ŠÌ Ò ¹¢ÒÂÂҢͧºÃÔ ÉÑ · Ï ãˌ ¶Ù ¡ µŒ Í § µÃ§¡Ñ º °Ò¹¢Œ Í ÁÙ Å ãºÍ¹Ø ­ Òµ¢ÒÂÂҢͧÊí Ò ¹Ñ ¡ §Ò¹¤³Ð¡ÃÃÁ¡Òà ÍÒËÒÃáÅÐÂÒ´Œ Ç Â

29


âäáÅСÒÃÃÑ¡ÉÒ

À­.©Ñ¹·Åѡɳ ¹ÀÕ礏 âç¾ÂÒºÒÅàǪ¡ÒÃسÃÈÑ ÁÔì ¹ÈÀ.ÃبÃÔ Ò ·ÇÕà©ÅÔÁ´ÔÉ° ¹Ñ¡ÈÖ¡ÉÒàÀÊѪÈÒʵÏ ªÑé¹»‚·Õè 5 Á.ËÑÇà©ÕÂÇà©ÅÔÁ¾ÃÐà¡ÕÂÃµÔ ¹ÈÀ.Í÷Ñ ÊÌÍ·ͧ ¹Ñ¡ÈÖ¡ÉÒàÀÊѪÈÒʵÏ ªÑé¹»‚·Õè 5 Á.ËÑÇà©ÕÂÇà©ÅÔÁ¾ÃÐà¡ÕÂõÔ

ʶҹ¡ÒóáÅÐá¹Ç⹌Á¡ÒÃÃкҴ㹵‹Ò§»ÃÐà·È

ͧ¤¡ÒÃ͹ÒÁÑÂâÅ¡ä´ŒÃºÑ ÃÒ§ҹâä䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ (H1N1) ³ Çѹ·Õè 4 µØÅÒ¤Á 2552 ÁÕ¨Òí ¹Ç¹¼Ù»Œ dž  ·Õäè ´ŒÃºÑ ¡ÒÃÇÔ¹¨Ô ©ÑÂÂ×¹Âѹ (confirmed cases) ÁÒ¡¡Ç‹Ò 375,000 ÃÒ áÅÐÁÕ¼àٌ ÊÕªÕÇµÔ ÁÒ¡¡Ç‹Ò 4,500 ÃÒ «Ö§è ¢ŒÍÁÙŹÕé µèíҡNjҤÇÒÁ໚¹¨ÃÔ§ÁÒ¡ à¹×èͧ¨Ò¡¡ÒÃÃкҴ䴌¢ÂÒÂä»ÊًªØÁª¹¢Í§»ÃÐà·Èµ‹Ò§æ ·ÑèÇâÅ¡áÅŒÇ ·Ñ駹Õ龺NjÒÅѡɳР·Ò§¾Ñ¹¸Ø¡ÃÃÁ (·Ñ§é antigenic áÅÐ genetic) ¢Í§àª×Íé 䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹µÇÑ ¹Õé ·Õµè ÃǨÇÔà¤ÃÒÐˏ·§Ñé ËÁ´ ÁÕÅ¡Ñ É³Ð àª‹¹à´ÕÂǡѺàª×éÍ A/California/7/2009-like H1N1 2009 ÂѧäÁ‹ÁÕ¡ÒÃà»ÅÕè¹á»Å§ÃËÑʾѹ¸Ø¡ÃÃÁ·ÕèÊíҤѭ¢Í§àª×éÍ áÅÐÂѧäÁ‹¾º»˜­ËÒ¡Òô×Íé ÂÒ oseltamivir ã¹ÃдѺ·Õàè »š¹»˜­ËÒ·Ò§ÊÒ¸ÒóÊØ¢ »ÃÐà·Èµ‹Ò§æ 㹫աâÅ¡·ÕÂè ҋ §à¢ŒÒÊÙċ ´Ù˹ÒÇ ¾ºÇ‹ÒÁÕ¡ÒÃÃкҴÁÕá¹Ç⹌Á¢ÂÒµÑÇÍ‹ҧÃÇ´àÃçÇ áÅÐã¹»‚µÍ‹ æ ä»ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ÁÕá¹Ç⹌Á¨Ð໚¹Ê‹Ç¹Ë¹Ö觢ͧ䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅã¹»ÃÐà·Èµ‹Ò§æ ·ÑèÇâÅ¡

ʶҹ¡ÒóáÅÐá¹Ç⹌Á¡ÒÃÃкҴ㹻ÃÐà·Èä·Â (¢ŒÍÁÙÅ ³ Çѹ·Õè 17 µØÅÒ¤Á 2552)

¨Ò¡¡ÒÃཇÒÃÐÇѧâä µÑ§é áµ‹Ç¹Ñ ·Õè 28 àÁÉÒ¹ 2552 ¶Ö§»˜¨¨Øº¹Ñ (17 µØÅÒ¤Á 2552) »ÃÐà·Èä·Â¾º¼Ù»Œ dž ·Õè 䴌ÃѺ¡ÒÃÇÔ¹Ô¨©ÑÂÂ×¹Âѹ (Confirmed cases) NjÒ໚¹ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ (H1N1) 2009 ÊÐÊÁ¨íҹǹ 28,057 ÃÒ àÊÕªÕÇµÔ 176 ÃÒ ¢ŒÍÁÙŪÕÇé ҋ ¡ÒÃÃкҴ䴌¢ÂÒµÑÇä»·Ø¡¨Ñ§ËÇÑ´·ÑÇè »ÃÐà·È¶Ö§ÃдѺÍíÒàÀÍ ¾º¼Ù»Œ dž ÂÂ×¹Âѹ¡Ç‹ÒÌÍÂÅÐ 90 ¢Í§ÍíÒàÀͷѧé ËÁ´ ã¹ÃͺÊͧÊÑ»´Òˏ·¼Õè ҋ ¹ÁÒ (3-17 µØÅÒ¤Á) ÁÕ¼»ÙŒ dž ÂÂ×¹Âѹà¾ÔÁè ¢Ö¹é 96 ÃÒ ¨Ò¡ËÅÒ¨ѧËÇÑ´ ઋ¹ ¨Ñ§ËÇÑ´¾ÐàÂÒ á¾Ã‹ àªÕ§ÃÒ ÌÍÂàÍç´ áÅÐÃÐÂͧ ã¹à´×͹µØÅÒ¤Á (1-17 µØÅÒ¤Á) ÁÕ¼»ÙŒ dž ÂàÊÕªÕÇµÔ 6 ÃÒ ¡ÒÃÃкҴ¢Í§ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹Â§Ñ ¤§Áյ͋ à¹×Íè §ã¹·Ø¡ÀÒ¤ â´Â੾ÒÐÀÒ¤à˹×Í (¨Ñ§ËÇÑ´á¾Ã‹ ¾ÐàÂÒ) áÅÐÀÒ¤µÐÇѹÍÍ¡à©Õ§à˹×Í Ê‹Ç¹ÀÒ¤¡ÅÒ§ÁÕá¹Ç⹌Á¡ÒÃÃкҴà¾ÔèÁ¢Öé¹ã¹ºÒ§¨Ñ§ËÇÑ´ ã¹ÀÒ¾ÃÇÁ¤Ò´Ç‹Ò㹪‹Ç§ 3 à´×͹¢ŒÒ§Ë¹ŒÒ¨¹¶Ö§»ÅÒ»‚ ¡ÒÃá¾Ã‹¡ÃШÒ¢ͧ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ã¹»ÃÐà·Èä·Â¨Ð´íÒà¹Ô¹µ‹Íä» áÅÐÍÒ¨¢ÂÒµÑÇ à»š¹¡ÒÃÃкҴÃÐÅÍ¡ãËÁ‹ËÒ¡ÁÕ»˜¨¨ÑÂàÊÃÔÁ ઋ¹ ÍÒ¡ÒÈ·ÕèàÂç¹Å§ ÁÕ¡ÒÃá¾Ã‹àª×éÍࢌÒÁÒ¨Ò¡»ÃÐà·È㹫աâÅ¡à˹×Í ÃÇÁ·Ñé§ËÒ¡¡Òû‡Í§¡Ñ¹âä㹻ÃÐà·ÈË‹͹»ÃÐÊÔ·¸ÔÀҾŧ

Åѡɳзҧ¤ÅÔ¹Ô¡

¢ŒÍÁÙŨҡ»ÃÐà·Èµ‹Ò§æ ÃÇÁ·Ñ駻ÃÐà·Èä·Â ªÕéNjҼٌ»†Ç·ÕèµÔ´àª×éÍ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ ʋǹãË­‹ÁÕÍÒ¡Òà ¤ÅŒÒÂ䢌ËÇÑ´ãË­‹ (Influenza-like illness: ILI) â´ÂäÁ‹ÁâÕ Ã¤á·Ã¡«ŒÍ¹ áÅÐËÒÂàͧ䴌ÀÒÂã¹Ë¹Ö§è ÊÑ»´Òˏ Í‹ҧäáçµÒÁàª×Íé ¹ÕÁé ÈÕ ¡Ñ ÂÀÒ¾·Õ¨è зíÒãˌà¡Ô´¾ÂÒ¸ÔÊÀҾ㹻ʹ ໚¹à˵Øãˌ¼»ÙŒ dž Âʋǹ˹֧è ÁջʹÍÑ¡àʺ ËÃ×ͻʹºÇÁ ÀÒÇлʹÍÑ¡àʺ㹼ٻŒ dž  ºÒ§ÃÒ¨ÐÅØ¡ÅÒÁÍ‹ҧÃÇ´àÃçÇ áÅкҧÃÒÂÁÕ¡ÒÃŌÁàËÅǢͧÃкºÍÇÑÂÇÐÍ×è¹Ã‹ÇÁ´ŒÇ «Ö觨íÒ໚¹µŒÍ§ä´ŒÃѺ¡ÒúíҺѴ ã¹ÀÒÇÐÇԡĵ áÅÐ໚¹ÀÒÃÐ˹ѡᡋÃкººÃÔ¡ÒÃÊÒ¸ÒóÊØ¢ ¼Ù»Œ dž ·ÕÁè »Õ Í´ÍÑ¡àʺ¨Ò¡àª×Íé 䢌ËÇÑ´ãË­‹ºÒ§ÃÒ¨ÐÁÕ¡Òà µÔ´àª×Íé Ấ·ÕàÃÕ«éÒí «ŒÍ¹´ŒÇ ¨íÒ໚¹µŒÍ§ÃÑ¡ÉÒ´ŒÇÂÂÒ»¯ÔªÇÕ ¹Ð ¼Ù»Œ dž ·Õàè ÊÕªÕÇµÔ Ê‹Ç¹ãË­‹à»š¹¼Å¨Ò¡ÃкºËÒÂã¨ÅŒÁàËÅÇ ¼Ù·Œ ÁÕè »Õ ¨˜ ¨ÑÂàÊÕÂè §µ‹ÍâäÃعáç 䴌ᡋ Ë­Ô§ÁÕ¤ÃÃÀ (â´Â੾ÒÐÍ‹ҧÂÔ§è ã¹ÃÐÂÐäµÃÁÒÊ·ÕÊè ÒÁ) à´ç¡ÍÒÂصÒèí ¡Ç‹Ò 2 ¢Çº áÅмٷŒ ÁÕè âÕ Ã¤»ÃШíÒµÑÇ â´Â੾ÒÐÍ‹ҧÂÔ§è âä»Í´ÍØ´¡Ñ¹é àÃ×Íé Ãѧ ËͺË×´ áÅÐâäËÑÇ㨠¡ÒÃãˌÂÒ»¯ÔªÇÕ ¹Ð䴌àÃçÇã¹ ÃÐÂеŒ¹¢Í§¡Òû†Ç ¨Ðª‹Ç»‡Í§¡Ñ¹»Í´ÍÑ¡àʺáÅÐâäá·Ã¡«ŒÍ¹ä´Œ â´Â੾ÒÐÍ‹ҧÂÔ§è ã¹¼Ù»Œ dž ·ÕÁè »Õ ¨˜ ¨ÑÂàÊÕÂè §µ‹ÍâäÃعáç 30


¡ÒÃÊíÒÃͧÂÒµŒÒ¹äÇÃÑÊáÅСÒèѴËÒÇѤ«Õ¹

ã¹¢³Ð¹Õ¡é ÃзÃǧÊÒ¸ÒóÊØ¢ ÊíÒÃͧÂÒµŒÒ¹äÇÃÑÊ oseltamivir ¡Ç‹Ò 12 ŌҹàÁç´ áÅÐ zanamivir ¨íҹǹ˹֧è â´Â¨Ñ´ÊÃÃänj·ÊÕè ¶Ò¹ºÃÔ¡ÒÃáÅФÅѧÂÒÃдѺµ‹Ò§æ «Ö§è ÁÕ»ÃÔÁÒ³à¾Õ§¾ÍÊíÒËÃѺÃÑ¡ÉÒ¼Ù»Œ dž ·ըè Òí ໚¹µŒÍ§ä´ŒÃºÑ ÂÒµÒÁá¹Ç·Ò§ ¡ÒÃÃÑ¡ÉÒ·Õ¡è ÃзÃǧÊÒ¸ÒóÊØ¢á¹Ð¹íÒ áÅÐͧ¤¡ÒÃàÀÊѪ¡ÃÃÁÂѧÊÒÁÒö¼ÅÔµ oseltamivir à¾ÔÁè àµÔÁä´ŒÍ¡Õ àÁ×Íè ¨íÒ໚¹ 31


¤ÇÒÁᵡµ‹ Ò §áÅФÇÒÁÃØ ¹ áç¢Í§ÍÒ¡ÒÃËÇÑ ´ áÅÐËÇÑ ´ ãË­‹ [3] ÍÒ¡ÒÃ

ËÇÑ´

¤ÇÒÁᵡµ‹Ò§¢Í§ÍÒ¡ÒÃ

䢌

â´ÂÁÒ¡äÁ‹¤Í‹ ÂÁÕÍÒ¡ÒÃ

»Ç´ËÑÇ »Ç´¡ÅŒÒÁà¹×Íé ͋͹à¾ÅÕ äÁ‹ÁáÕ Ã§ ¡ÅŒÒÁà¹×Íé äÁ‹ÁáÕ Ã§

â´ÂÁÒ¡äÁ‹¤Í‹ ÂÁÕÍÒ¡Òà ¾ºä´ŒºÒŒ §áÅÐäÁ‹¤Í‹ ÂÃعáç ¾ºä´ŒºÒŒ §áÅÐäÁ‹¤Í‹ ÂÃعáç â´ÂÁÒ¡äÁ‹¤Í‹ ÂÁÕÍÒ¡ÒÃ

¤Ñ´¨ÁÙ¡ ¹éíÒÁÙ¡äËÅ «ÖÁ §‹Ç§ à¨çº¤Í Ãкº·Ò§à´Ô¹ËÒÂ㨵Դ¢Ñ´/äÍ ÍÒ¡ÒÃá·Ã¡«ŒÍ¹

¾ºº‹Í ¾ºº‹Í ¾ºº‹Í ¾ºä´ŒºÒŒ § áÅÐäÁ‹¤Í‹ ÂÃعáç ¡ÒõԴàª×Íé ã¹â¾Ã§ÍÒ¡ÒÈ (䫹ÑÊ) ËÙÍ¡Ñ àʺ

¡Òû‡Í§¡Ñ¹

ŌҧÁ×ÍÍÂÙà‹ ÊÁÍ

ËÇÑ´ãË­‹

¾ºº‹Í â´ÂÁÑ¡ÁÕ䢌ʧ٠»ÃÐÁÒ³ 39-40oC ¹Ò¹ 3-4 Çѹ ¾ºº‹Í áÅФ‹Í¹¢ŒÒ§Ãعáç ¾ºº‹Í áÅФ‹Í¹¢ŒÒ§Ãعáç ¾ºº‹ÍÂáÅÐÃعáç ¹Ò¹ 2-3 Çѹ ¢Ö¹é ä» ¾ºº‹ÍÂ㹪‹Ç§áá¢Í§ÃÐÂÐà¡Ô´âä áÅФ‹Í¹¢ŒÒ§Ãعáç ¾ºº‹Í ¾ºä´ŒºÒŒ § ¾ºº‹Í ¾ºº‹Í áÅФ‹Í¹¢ŒÒ§Ãعáç ¡ÒõԴàª×Íé ·Õ»è Í´ Ãкº·Ò§à´Ô¹ËÒÂã¨ÅŒÁàËÅÇ ·íÒãˌâäàÃ×Íé Ãѧ·Õàè »š¹ÍÂÙà‹ ÅÇÌÒ¶֧¢Ñ¹é àÊÕªÕÇµÔ ä´Œ ŌҧÁ×ÍÍÂÙà‹ ÊÁÍ

¢¹Ò´ÂÒáÅÐÃÐÂÐàÇÅÒ¡ÒÃãˌ  Òà¾×è Í ÃÑ ¡ ÉÒáÅл‡ Í §¡Ñ ¹ 䢌 Ë ÇÑ ´ ãË­‹ Ê ÒÂ¾Ñ ¹ ¸Ø ã ËÁ‹ ª ¹Ô ´ A (H1N1) ÂÒ Oseltamivir ¼ÙŒ ã Ë­‹ à´ç ¡ ÍÒÂØ Á Ò¡¡Ç‹ Ò 12 »‚ ¾Ô¨ÒóҵÒÁ¹éíÒ˹ѡµÑÇ (kg) < 15 kg 15 kg - 23 kg 23 kg - 40 kg > 40 kg à´ç ¡ ÍÒÂØ ¹Œ Í Â¡Ç‹ Ò 1 ¢Çº < 3 à´×͹ 3-5 à´×͹ 6-11 à´×͹ Zanamivir (Relenza ® ) [powder inhalation] ¼ÙŒ ã Ë­‹ à´ç¡ (> 7 ¢Çº ÊíÒËÃѺ¡ÒÃÃÑ¡ÉÒ áÅÐ > 5 ¢Çº ÊíÒËÃѺ¡Òû‡Í§¡Ñ¹)

¡ÒÃÃÑ ¡ ÉÒ (ãˌ  ҹҹ 5 ÇÑ ¹ )

¡Òû‡ Í §¡Ñ ¹ (ãˌ  ҹҹ 10 ÇÑ ¹ )

75 mg capsule ÇѹÅÐ 2 ¤ÃÑé§

75 mg capsule ÇѹÅÐ 1 ¤ÃÑé§

30 mg ÇѹÅÐ 2 ¤ÃÑé§ 45 mg ÇѹÅÐ 2 ¤ÃÑé§ 60 mg ÇѹÅÐ 2 ¤ÃÑé§ 75 mg ÇѹÅÐ 2 ¤ÃÑé§

30 mg ÇѹÅÐ 1 ¤ÃÑé§ 45 mg ÇѹÅÐ 1 ¤ÃÑé§ 60 mg ÇѹÅÐ 1 ¤ÃÑé§ 75 mg ÇѹÅÐ 1 ¤ÃÑé§

12 mg ÇѹÅÐ 2 ¤ÃÑé§ 20 mg ÇѹÅÐ 2 ¤ÃÑé§ 25 mg ÇѹÅÐ 2 ¤ÃÑé§

äÁ‹á¹Ð¹íÒ 20 mg ÇѹÅÐ 1 ¤ÃÑé§ 25 mg ÇѹÅÐ 1 ¤ÃÑé§

ÊÙ´ÂÒ ¢¹Ò´ 10 mg (¢¹Ò´ 5 mg/ÊÙ´ ¨íҹǹ 2 ÊÙ´) 2 ¤ÃÑé§/Çѹ ÊÙ´ÂÒ ¢¹Ò´ 10 mg 2 ¤ÃÑé§/Çѹ (¢¹Ò´ 5 mg/ÊÙ´ ¨íҹǹ 2 ÊÙ´) 2 ¤ÃÑé§/Çѹ

ÊÙ´ÂÒ ¢¹Ò´ 10 mg (¢¹Ò´ 5 mg/ÊÙ´ ¨íҹǹ 2 ÊÙ´) 1 ¤ÃÑé§/Çѹ ÊÙ´ÂÒ ¢¹Ò´ 10 mg (¢¹Ò´ 5 mg/ÊÙ´ ¨íҹǹ 2 ÊÙ´) 2 ¤ÃÑé§/Çѹ

¢¹Ò´ÂÒ Oseltamivir ¡Ã³Õ ¼ÙŒ »† Ç ÂÁÕ ¡ Ò÷í Ò §Ò¹¢Í§äµº¡¾Ã‹ Í § ¿ ClCr 10-30 ml/min : 75 mg ÇѹÅÐ 1 ¤ÃÑé§ ¿ ¼ÙŒ»†Ç¿͡䵷ҧª‹Í§·ŒÍ§ : 30 mg ÊÑ»´ÒˏÅÐ 1 ¤ÃÑé§ ¿ ¼Ù» Œ dž ¿͡䵴ŒÇÂà¤Ã×Íè §äµà·ÕÂÁ : 30 mg ·Ø¡ 2 Ãͺ¢Í§¡ÒÃŌҧäµ[4] 32


+-

Ō Ò §Á× Í Í‹ Ò §äÃ...ãˌ Ê ÐÍÒ´ »ÃÒȨҡâä ·Õè Á Ò : ¡Í§ÊØ ¢ ÈÖ ¡ ÉÒ ¡ÃÁÊ¹Ñ º Ê¹Ø ¹ ºÃÔ ¡ ÒÃÊØ ¢ ÀÒ¾ ¡ÃзÃǧÊÒ¸ÒóÊØ ¢

¡ÃзÃǧÊÒ¸ÒóÊآ䴌ÊÑ觫×éÍÇѤ«Õ¹ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ (H1N1) änj㹢Ñé¹µŒ¹ ¨íҹǹ 2 Ōҹ dose â´ÂÅíҴѺáá¨Ð㪌ÊíÒËÃѺ»‡Í§¡Ñ¹âä㹡Å؋ÁºØ¤ÅÒ¡ÃÊÒ¸ÒóÊØ¢·ÕèàÊÕ觵‹Í¡ÒõԴàª×éÍ㹡Òû¯ÔºÑµÔ˹ŒÒ·Õè áÅлÃЪҪ¹ ¡Å؋Á·ÕèÁÕ»˜¨¨ÑÂàÊÕ觵‹ÍâäÃعáç ÅѡɳÐÇѤ«Õ¹à»š¹ÇѤ«Õ¹·Õè¼ÅÔµ¨Ò¡àª×é͵Ò (Inactivated vaccine) ¤Ò´Ç‹Ò¨ÐÊÒÁÒö ¹íÒÁÒãˌºÃÔ¡ÒÃ䴌㹪‹Ç§µŒ¹»‚ 2553 ¹Í¡¨Ò¡¹Õ¡é ÃзÃǧÊÒ¸ÒóÊØ¢¡íÒÅѧ´íÒà¹Ô¹â¤Ã§¡ÒþѲ¹ÒáÅмÅÔµÇѤ«Õ¹ä¢ŒËÇÑ´ãË­‹ ÊÒ¾ѹ¸ØãËÁ‹ (H1N1) 2009 ª¹Ô´àª×éÍÁÕªÕÇԵ͋͹ķ¸Ôì (Live attenuated vaccine) «Öè§Ëҡ໚¹¼ÅÊíÒàÃç¨áÅÐ䴌ÃѺ ¡ÒâÖé¹·ÐàºÕ¹ ¨Ð¾Ô¨ÒóҼÅÔµáÅйíÒÁÒ㪌»‡Í§¡Ñ¹âäã¹ÃÐÂе‹Íä»[1]

¡ÒÃãˌÂÒµŒÒ¹äÇÃÑÊ

àÃÔèÁÂÒ oseltamivir ·Ñ¹·Õ â´ÂäÁ‹µŒÍ§ÃͼšÒõÃǨäÇÃÑÊ ¤ÇÃãˌÂÒ¹Ò¹ 5 Çѹ ᵋËҡ໚¹¼ÙŒ»†ÇÂ˹ѡ ËÃ×ÍÂѧÁÕÍÒ¡ÒÃ˹ѡàÁ×èÍÃÑ¡ÉÒ䴌 5 Çѹ ãˌ¡Ô¹ÂÒµ‹ÍÍÕ¡ 5 Çѹ ÃÇÁ໚¹ 10 Çѹ ¿ äÁ‹ËÂØ´ÂÒ¡‹Í¹¡íÒ˹´áÁŒÇ‹Ò¼Å¡ÒõÃǨ¨Ð¾ºà»š¹Åºã¹ÀÒÂËÅѧ ¨ÐËÂØ´ÂÒ¡‹Í¹¡íÒ˹´ä´ŒàÁ×è;ºáÅÐ à»ÅÕ蹡ÒÃÇÔ¹Ô¨©ÑÂÊÒà˵آͧ»Í´ÍÑ¡àʺNjÒà¡Ô´¨Ò¡ÊÒà˵ØÍ×è¹à·‹Ò¹Ñé¹ ¿ ¼Ù» Œ dž »ʹÍÑ¡àʺ·ÕÍè Ò¡ÒÃÃعáçÁÒ¡ ËÃ×ÍäÁ‹¤Í‹ µͺʹͧµ‹Í¡ÒÃÃÑ¡ÉÒÍÒ¨¾Ô¨ÒóÒãˌ zanamivir ËÇÁ´ŒÇ ¿ ¢¹Ò´ÂÒ oseltamivir â´Â·ÑèÇä»ã¹¼ÙŒãË­‹ ¤×Í 75 Á¡. µ‹Í¤ÃÑé§ ÇѹÅÐ 2 ¤ÃÑé§ã¹¤¹ÍŒÇ¹ÁÒ¡ ÍÒ¨¨Ð¾Ô¨ÒÃ³Ò ãˌ໚¹Êͧ෋Ңͧ¤¹»¡µÔ ËÃ×Í 150 Á¡. µ‹Í¤ÃÑé§ ÇѹÅÐ 2 ¤ÃÑé§[4] ¿

33


Í‹ҧäáçµÒÁ ¾ºÇ‹Ò¡ÒÃÃкҴ ¢Í§ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ A (H1N1) Âѧ¤§ÁÕÍ‹ҧµ‹Íà¹×èͧ ËÒ¡»ÃЪҪ¹äÁ‹àËç¹ ¤ÇÒÁÊí Ò ¤Ñ ­ áÅТҴ¤ÇÒÁË Ç ÁÁ× Í Ã‹ Ç Á㨠¡çÂÒ¡·Õè¨ÐÃѺÁ×͡Ѻâä¹Õé䴌 ´Ñ§¹Ñ鹨֧¤Çà µÃÐ˹ѡ¶Ö§¡Òû‡Í§¡Ñ¹µ¹àͧáÅФÃͺ¤ÃÑÇ ãˌ»ÅÍ´ÀѨҡâä â´Â¡ÒÃËÇÁ¡Ñ¹ÊÌҧ ¤‹Ò¹ÔÂÁ㹡ÒÃÊÇÁ˹ŒÒ¡Ò¡Í¹ÒÁÑ àÁ×èÍ໚¹ ËÇÑ´ËÃ×ÍâäµÔ´àª×éÍ·Ò§à´Ô¹ËÒÂã¨Í×è¹æ ¤Çà ËÁѹè ŌҧÁ×ÍãˌÊÐÍÒ´ÍÂÙà‹ ÊÁÍà¾×Íè »‡Í§¡Ñ¹¡Òà á¾Ã‹¡ÃШÒÂàª×éÍÃÐËNjҧºØ¤¤Å·Ñ駷ҧµÃ§ áÅзҧ͌ÍÁ ઋ¹ ¡ÒÃÊÑÁ¼ÑʵÑÇ¡ÅÒ§ ¾Ç¡ÅÙ¡ ºÔ´-»Ãе٠ⵍРࡌÒÍÕé ໚¹µŒ¹ ¹Í¡¨Ò¡¼Ù»Œ dž  áÅŒÇ ¤¹»¡µÔ¡¤ç ÇÃŌҧÁ×ÍãˌÊÐÍҴ໚¹¹ÔÊÂÑ à¹×Íè §¨Ò¡¡ÒÃ㪌ÁÍ× á¤Ð䪨ÁÙ¡ ËÃ×Í¢ÂÕµé ҨзíÒ ãËŒä´ŒÃºÑ àª×Íé âäࢌÒÊÙË ҋ §¡Ò·ҧàÂ×Íè ºØµÒáÅÐ ¨Á١䴌

ÇÔ ¸Õ Ê ÇÁ˹Œ Ò ¡Ò¡Í¹ÒÁÑ Â ·Õè Á Ò : âç¾ÂÒºÒÅʧ¢ÅÒ¹¤ÃÔ ¹ ·Ã Reference : 1. ¢ŒÍÁÙÅʶҹ¡ÒóáÅÐá¹Ç·Ò§¡ÒèѴ¡ÒáÒÃÃкҴ¢Í§ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ã¹ª‹Ç§Ä´Ù˹ÒÇ¡ÃзÃǧÊÒ¸ÒóÊØ¢ ³ Çѹ·Õè 22 µØÅÒ¤Á 2552. Availabel from : http://beid.ddc.moph.go.th/th [October 25, 2009] 2. ¤³Ð·íÒ§Ò¹´ŒÒ¹¡ÒÃÃÑ¡ÉÒ¾ÂÒºÒÅ ¡ÃзÃǧÊÒ¸ÒóÊØ¢. á¹Ç·Ò§¡ÒôÙáÅÃÑ¡ÉҼٌ»†Ç·ÕèࢌҢ‹ÒÂʧÊÑÂ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ A (H1N1) ©ºÑº»ÃѺ»Ãا¤ÃÑ§é ·Õè 3 (17 ¡Ã¡®Ò¤Á 2552). Availabel from :http://www.moph.go.th/hot/content.pdf [October 20, 2009] 3. À­.¸ÁÅÇÃó ¸ÕúѭªÃ. àÃÕ¹Ãٌ ÊÙˌ ÇÑ´. ͧ¤¡ÒÃàÀÊѪ¡ÃÃÁ. Availabel from : http://www.gpo.or.th/Default.aspx?tabid=86&language=thTH [October 20, 2009] 4. ÊØDz Ñ ¹Ò ¨ØÌÒÇѲ¹·Å, ºØÉºÒ ¨Ô¹´ÒÇÔ¨¡Ñ ɳ, »ÃÕªÒ Á¹·¡Ò¹µÔ¡ÅØ , áÅФ³Ð, ºÃóҸԡÒà . Advances in Pharmacotherapeutics and Pharmacy Practice 2009:7-8.

34


À­.¼È.¹ÔµÂÒÇÃó ¡ØųÒÇÃó

ÂÒáÅСÒÃ㪌ÂÒ

º·¹íÒ

à¹×èͧ¨Ò¡¼ÅÔµÀѳ±ÊÁعä¾Ã·ÕèÁÕ¨íÒ˹‹ÒÂã¹µÅÒ´ÁդسÀÒ¾ ËÅÒ¡ËÅÒ â´Â੾ÒСÒüÅÔ µ ã¹ÃÙ » ẺàÊÃÔ Á ÍÒËÒÃÁÔ ã ª‹ Â Ò ¡Ãкǹ¡ÒüÅÔ µ ÂÑ § äÁ‹ à ¢Œ Á §Ç´àËÁ× Í ¹¡ÒüÅÔ µ ÂÒ ÍÕ ¡ ·Ñé § ÁÕ ¡ Òà »ÃЪÒÊÑÁ¾Ñ¹¸ ÁÑ¡ÍǴ͌ҧÊÃþ¤Ø³·Ò§ÂÒ ´Ñ§¹Ñ¹é ¨Ö§à»š¹¤ÇÒÁÃѺ¼Ô´ªÍº ¢Í§áËŋ§¼ÅÔµàͧ㹡ÒûÃСѹ¤Ø³ÀÒ¾¢Í§ÊÔ¹¤ŒÒ¢Í§µ¹àͧNjÒࢌÁ§Ç´ ÁÒ¡¹ŒÍÂà¾Õ§äÃ㹡ÒõÃǨÊͺÁҵðҹ¤Ø³ÀÒ¾¢Í§Çѵ¶Ø´Ôº áÅÐ ¡Ãкǹ¡ÒüÅÔµÁÕÁҵðҹ·Õè´Õà¾Õ§㴠¼ÙŒºÃÔâÀ¤áÅкؤÅҡ÷ҧ ¡ÒÃᾷ¨ÐµŒÍ§ãªŒ´ØžԹԨÍ‹ҧ¶Õ趌ǹáÅÐÃͺ¤Ãͺ㹡ÒÃàÅ×͡㪌 ¼ÅÔµÀѳ± ã¹»ÃÐà´ç¹àËŋҹÕé 1 . ¶ŒÒÇѵ¶Ø´Ôºà»š¹ÊÁعä¾Ã¨ÐµŒÍ§ä´ŒÃѺ¡ÒõÃǨ¾ÔÊÙ¨¹ à¾×èÍ Â×¹Âѹª¹Ô´¢Í§ÊÁعä¾Ã·Õµè çµÒÁµŒÍ§¡Òà (plant identification) 2 . ¨ÐµŒÍ§ÁÕ¡ÒÃÇÔà¤ÃÒÐˏËÒ»ÃÔÁÒ³ÊÒÃÊíҤѭã¹ÊÁعä¾Ã ¹Ñé¹Ç‹ÒÁÕ»ÃÔÁÒ³µÒÁÁҵðҹ¡íÒ˹´ËÃ×ÍäÁ‹ 3 . ¨ÐµŒÍ§ÁÕ¡ÒÃÇÔà¤ÃÒÐˏËÒ»ÃÔÁÒ³ÊÒÃäÁ‹¾Ö§»ÃÐʧ¤·Õè໚¹ ʋǹ»ÃСͺã¹ÊÁعä¾ÃNjÒÁÕ»ÃÔÁÒ³¨íÒ¡Ñ´µÒÁÁҵðҹËÃ×ÍäÁ‹ 4 . ¨ÐµŒÍ§ÇÔà¤ÃÒÐˏ»ÃÔÁÒ³âÅËÐ˹ѡ·Õ軹ໄœÍ¹ 5 . ¨ÐµŒÍ§ÇÔà¤ÃÒÐˏ»ÃÔÁҳẤ·ÕàÃÕ 6 . ÁÕ¡Ãкǹ¡ÒüÅÔµ·ÕèÁÕÁҵðҹ·Õè¶Ù¡µŒÍ§áÅÐã¡ÅŒà¤Õ§¡ÑºÁҵðҹ·Õè´Õ㹡ÒüÅÔµÂÒ 7 . ¨Ñ ´ ¾Ô Á ¾ © ÅÒ¡¶Ù ¡ µŒ Í §µÃ§µÒÁ¤Ø ³ ÀÒ¾ ©ÅÒ¡µŒ Í §ÃÐºØ » ÃÔ Á Ò³ÊÒÃÊí Ò ¤Ñ ­ ã¹¼ÅÔ µ ÀÑ ³ ± µ‹ Í Ë¹‹ Ç Â àª‹ ¹ ¼ÅÔµÀѳ±¢§Ô ÊíÒàÃç¨ÃÙ»ÃкØÇҋ ᵋÅÐ᤻«ÙÅ»ÃСͺ´ŒÇ¢ԧ¼§ 300 ÁÔÅÅÔ¡ÃÑÁà·ÕÂºà·‹Ò gingerol 5 à»ÍÏà«ç¹µ ¤ÇÃÁÕ¢¹Ò´ ÃѺ»ÃзҹÃкØänjªÑ´à¨¹

ÊÔ§è ·Õàè ÀÊѪ¡Ã¤ÇÃÊͺ¶ÒÁ¼ÙºŒ ÃÔâÀ¤¡‹Í¹á¹Ð¹íÒ¼ÅÔµÀѳ±¸ÃÃÁªÒµÔà¾×Íè àÊÃÔÁ¡ÒÃÃÑ¡ÉÒ ËÃ×ÍàÊÃÔÁÊØ¢ÀÒ¾ 1. 2. 3. 4. 5. 6. 7. 8. 9.

¢³Ð¹ÕéºÃÔâÀ¤ÂÒÍÐäÃÍÂًºŒÒ§ ¢³Ð¹Õãé ªŒ¼ÅÔµÀѳ±àÊÃÔÁÍÒËÒÃÍÐäÃÍÂÙº‹ Ҍ § ¶ŒÒ㪌ÍÂÙÁ‹ ¢Õ ͌ ÊѧࡵNjÒà¡Ô´ÍÒ¡ÒÃäÁ‹¾§Ö »ÃÐʧ¤ËÃ×ÍäÁ‹ ¢¹Ò´ÂÒáÅмÅÔµÀѳ±àÊÃÔÁÍÒËÒ÷Õãè ªŒÍÂً »˜­ËÒ¤ÇÒÁà¨çº»†Ç¤×ÍÍÐäà µÑ§é ¤ÃÃÀËÃ×ÍäÁ‹ ¡íÒÅѧãˌ¹ÁºØµÃËÃ×ÍäÁ‹ ÍÒÂآͧ¼ÙºŒ ÃÔâÀ¤ »ÃÐÇѵÀÔ ÁÙ áÔ ¾Œ (ÂÒ/ÍÒËÒÃ/Í×¹è æ)

35


ËÅÑ¡¤ÇÃÃÐÇѧàÁ×èÍá¹Ð¹íÒ¡ÒÃ㪌¼ÅÔµÀѳ±¸ÃÃÁªÒµÔ

1. äÁ‹¤ÇÃ㪌¡ºÑ à´ç¡·ÕÍè ÒÂصÒèí ¡Ç‹Ò 2 ¢Çº 2. µŒÍ§·ÃҺNjҼÅÔµÀѳ±Á¢Õ ͌ ˌÒÁ㪌ÊÒí ËÃѺ˭ԧÁÕ¤ÃÃÀËÃ×ÍË­Ô§ ãˌ¹ÁºØµÃ 3. µŒÍ§ÁÕ¤ÇÒÁÃÙàŒ ¡ÕÂè ǡѺķ¸Ôàì ÀÊѪÇÔ·ÂÒáÅл¯Ô¡ÃÔ ÂÔ ÒÃÐËNjҧÂҡѺ ¼ÅÔµÀѳ± 4. µŒÍ§ÃÙ͌ Ò¡ÒÃäÁ‹¾§Ö »ÃÐʧ¤Ëҡ㪌¼ÅÔµÀѳ±µÍ‹ à¹×Íè §¹Ò¹ËÃ×Í »ÃÔÁÒ³ÁÒ¡ 5. µŒÍ§ÁÕ¤ÇÒÁÃÙʌ Ò¾ѹ¸Ø¢ ͧÊÁعä¾ÃáÅÐÊÒÃÊíҤѭ·ÕÍè Ò¨¡‹Íãˌà¡Ô´ ÍÒ¡ÒâŒÒ§à¤Õ§ 6. ÁÕ¤ÇÒÁÃٌáËŋ§¼ÅÔµ·Õèàª×èͶ×Í

»¯Ô¡ÔÃÔÂÒÃÐËNjҧÊÁعä¾ÃáÅÐÂÒ

áÁŒÊÁعä¾Ã·Õãè ªŒÁÊÕ Ãþ¤Ø³µÃ§µÒÁ¤ÇÒÁµŒÍ§¡ÒèÃÔ§ ÊÔ§è ·Õ¾è §Ö µÃÐ˹ѡ¤×Í ÊÒÃÊíҤѭã¹ÊÁعä¾Ã ÁÕÄ·¸Ô·ì Ò§ÂÒ ¨Ö§ÍÒ¨ÁÕ¼Åà»ÅÕÂè ¹á»Å§àÀÊѪ¨Å¹ÈÒʵÏËÃ×ÍàÀÊѪ¾ÅÈÒʵϢͧÂÒ·Õãè ªŒÃNj Á «Ö§è ¼Å·Õàè ¡Ô´¢Ö¹é ÍÒ¨ ÁÕ·§Ñé ʋ§àÊÃÔÁ ËÃ×͵ŒÒ¹Ä·¸ÔÂì Ò·Õãè ªŒÍÂً ´Ñ§µÑÇÍ‹ҧ¢ŒÍÁÙŢͧÊÁعä¾Ã·Õ¹è ÂÔ Á㪌 ઋ¹

»¯Ô¡ÔÃÔÂÒÃÐËNjҧÂÒ-¡ÃÐà·ÕÂÁ

1 . Dipyridamole, Indomethacin, Warfarin : ÊÒà Ajoene 㹡ÃÐà·ÕÂÁàÊÃÔÁÄ·¸Ô쵌ҹ¡Òà à¡ÒСÅØÁ‹ à¡Åç´àÅ×Í´¢Í§ÂÒ dipyridamole áÅÐ indomethacin (Apitz-Castro et al., 1986) 2 . Warfarin : ¹éÒí Áѹ¡ÃÐà·ÕÂÁ à¾ÔÁè ¡ÒÃÊÅÒ fibrin 63-69 % ã¹¼Ù»Œ dž  myocardial infarction ·Õè䴌ÃѺ warfarin ¨Ö§·íÒãˌà¾ÔÁè Ä·¸Ô¢ì ͧ warfarin (Bordia et al.,1977;Stockley,1999)

»¯Ô¡ÃÔ ÂÔ ÒÃÐËNjҧÂÒ-Ginkgo biloba extract (GBE)

1 . ÍÒ¨ÁÕ»¯Ô¡ÃÔ ÂÔ Ò¡Ñº¡ÅØÁ‹ ÂÒµŒÒ¹¡ÒÃá¢ç§µÑǢͧàÅ×Í´ ઋ¹ aspirin, clopidogrel, dipyridamole, ticlopidine, warfarin ¨Ö§äÁ‹¤ÇÃ㪌ÃNj Á¡Ñ¹ ¡ÒÃ㪌 GBE ËÇÁ¡Ñº warfarin ·íÒãˌàÊÕ觵‹Í¡ÒÃà¡Ô´ÀÒÇÐàÅ×Í´äËÅäÁ‹ËÂØ´ à¤ÂÁÕÃÒ§ҹ㹠¼Ù»Œ dž ÂË­Ô§ÍÒÂØ 78 »‚ ·Õãè ªŒ Ginkgo ËÇÁ¡Ñº warfarin ÁÕÍÒ¡Òà intracerebral hemorrhage (Matthew,1998) áÅÐÁÕÃÒ§ҹ㹼ٻŒ dž ÂÍÒÂØ 70 »‚ 㪌 ginkgo 40 Á¡. ËÇÁ¡Ñº aspirin 325 Á¡. à¡Ô´àÅ×Í´ÍÍ¡ã¹ anterior chamber ¢Í§ÅÙ¡¹Ñ¹µÒ (Rosenbaltt and Mindel,1997) 2 . »¯Ô ¡Ô ÃÔ Â Ò¡Ñ º papavarine GBE àÊÃÔ Á Ä·¸Ôì ¢ ͧ papavarine 㹡ÒÃÃÑ ¡ ÉÒ¤¹ä¢Œ ·ÕËè ‹͹ÊÁÃöÀÒ¾·Ò§à¾È (Sikora et al.,1989) ´Ñ§¹Ñ¹é ¨Ö§àËÁÒСѺ¤¹ä¢Œ erectile dysfunction ·Õãè ªŒ papavarine äÁ‹¤Í‹ Â䴌¼Å 3 . »¯Ô¡ÃÔ ÂÔ Ò¡Ñº thiazide diuretics Shaw áÅФ³Ð (Shaw et al., 1991) ä´ŒÈ¡Ö ÉÒ¾ÔÉÇÔ·ÂÒ ¢Í§ÂÒÊÁعä¾ÃáÅÐÍÒËÒÃàÊÃÔÁµÅÍ´ÃÐÂÐàÇÅÒ 5 »‚ ¾º¼Ù»Œ dž Âà¾Õ§˹֧è ÃÒ·Õãè ªŒ ginkgo ËÇÁ¡Ñº thiazide áŌǤÇÒÁ´Ñ¹âÅËÔµÊÙ§¢Ö¹é ᵋ㹡ÒÃÇÔ¨ÂÑ ·Ò§¤ÅÔ¹¡Ô ÂѧäÁ‹à¤ÂÁÕÃÒÂ§Ò¹Ç‹Ò ginkgo ·íÒãˌ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ 4. »¯Ô¡ÔÃÔÂҡѺ trazodone àÁ×èÍàÃçÇæ ¹ÕéÁÕÃÒÂ§Ò¹Ç‹Ò ÊÒà flavonoids ã¹ Ginkgo biloba àÊÃÔÁÄ·¸Ô¡ì ´ÊÁͧ¢Í§ trazodone (Galluzzi et al., 2000) à¡Ô´¡Ñº¤¹ä¢Œ Alzheimer ÍÒÂØ 80 »‚ ÃѺ»Ãзҹ trazodone 20 Á¡. ÇѹÅÐÊͧ¤Ãѧé ËÇÁ¡Ñº GBE 80 Á¡. ÇѹÅÐÊÒÁ¤Ãѧé ÊÒÁÇѹµÔ´µ‹Í¡Ñ¹ ¤¹ä¢Œà¡Ô´ÍÒ¡ÒÃâ¤Á‹Ò 36


»¯Ô¡ÔÃÔÂÒÃÐËNjҧÂÒ-ªÒà¢ÕÂÇ

1. Beta-lactam Antibiotic : ¡ÒÃÈÖ¡ÉÒã¹ËŒÍ§»¯ÔºÑµÔ¡ÒþºÇ‹ÒÊÒà epicatechin gallate àÊÃÔÁÄ·¸Ôì ÂÒ¡ÅØÁ‹ Beta-lactam antibiotic 㹡ÒõŒÒ¹àª×Íé methicillin-resistant Staphylococcus areus (MRSA) (Shiota et al.,1999) MRSA ໚¹àª×Íé ·Õáè ¾Ã‹ã¹âç¾ÂÒºÒÅâ´Â·ÑÇè ä»ÁÑ¡´×Íé µ‹Í Beta-lactam antibiotic 2. Doxorubicin : ÊÒà theanine «Ö§è ໚¹ÊÒáôÍÐÁÔâ¹ã¹ªÒà¢ÕÂÇ à¾ÔÁè Ä·¸Ôµì Ҍ ¹à«ÅŏÁÐàÃ秢ͧÂÒ doxorubicin ÁÕÃÒ§ҹ¡ÒÃ㪌ÊÒà theanine (10 mg/day) ËÇÁ¡Ñº doxorubicin (2mg/kg/day) ÊÒÁÒö Å´¢¹Ò´¡ŒÍ¹à¹×Íé §Í¡Ãѧ䢋䴌¶§Ö 30 % áÅÐÅ´á¾Ã‹¡ÃШÒÂä»ÂѧµÑºä´Œ (Sugiyama and Sadzuka, 1999) ¡ÒÃ㪌 doxorubiciin ËÇÁ¡ÑºªÒà¢ÕÂǪ‹ÇÂà¾ÔèÁÃдѺÂÒ·Õèà¹×éÍÁÐàÃç§áµ‹äÁ‹à¾ÔèÁà¹×éÍàÂ×èÍ»¡µÔ á¹Ð¹íÒãˌ¤¹ä¢Œ ·Õäè ´ŒÃºÑ ÂÒµŒÒ¹ÁÐàÃ秴×Áè ªÒà¢ÕÂÇËÇÁáÁŒÂ§Ñ äÁ‹Á¼Õ Å¡ÒÃÇÔ¨ÂÑ ·Ò§¤ÅÔ¹¡Ô ªÑ´à¨¹ÁÒÂ×¹Âѹ 3 . Tamoxifen ¡ÒÃÈÖ¡ÉÒã¹ËŒÍ§»¯ÔºµÑ ¡Ô Òà 㪌ÊÒÃÊ¡Ñ´ªÒà¢ÕÂÇËÇÁ¡Ñº tamoxifen à¾ÔÁè ÍѵÃÒ¡ÒõÒ ¢Í§à«ÅŏÁÐàÃç§ à¹×Íè §¨Ò¡Ä·¸Ô¢ì ͧÊÒà (-) -epigallocatechin gallate (EGCG) (Suganuma,1999) 4 . Warfarin ¡Òô×Áè ªÒà¢ÕÂÇÁÒ¡æ ¨Ð·íÒãˌķ¸Ô¢ì ͧ warfarin Ŵŧ à¹×Íè §¨Ò¡ªÒà¢ÕÂÇÁÕÇµÔ ÒÁÔ¹ K (»ÃÐÁÒ³ 0.03 microgram/ÊÒÃÊ¡Ñ´ 100 ¡ÃÑÁ) «Ö§è µŒÒ¹Ä·¸Ô¢ì ͧ warfarin (Taylor and Wilt,1999)

»¯Ô¡ÃÔ ÂÔ ÒÃÐËNjҧÂÒ-Evening Primrose Oil (EPO)

EPO à¾ÔÁè Ä·¸Ô¡ì ÒáÃеعŒ ¡Òêѡ¢Í§ phenothiazines ¨Ö§äÁ‹¤ÇÃ㪌ÃNj Á¡Ñ¹ (Shaw, et al.,1991)

»¯Ô¡ÃÔ ÂÔ ÒÃÐËNjҧÂÒ-St. John’s wort

ÊÁعä¾Ãª¹Ô´¹Õ鵌ҹ¡ÒëÖÁàÈÃŒÒ ÍÍ¡Ä·¸Ôì໚¹ MAOIs áÅÐÁÕÄ·¸Ôì໚¹ SSRI ÍÂ‹Ò§Í‹Í¹æ ¹Í¡¨Ò¡¹ÕéÂѧÁÕÄ·¸Ôì໚¹ÊÒáÃе،¹à͹ä«Á·ÕèµÑº«Öè§à»š¹à͹ä«Á·Õè㪌㹡ÒÃà»ÅÕè¹á»Å§ÂÒËÅÒª¹Ô´ ¨Ö§ÍÒ¨Áռŵ‹Í¡ÒÃà»ÅÕÂè ¹á»Å§µÑÇÍ×¹è æ ·íÒãˌÃдѺã¹àÅ×Í´µèÒí ŧ ¨Ö§äÁ‹¤ÇÃ㪌 St.John’s wort ËÇÁ¡ÑºÂÒ àËŋҹÕé digoxin, MAOIs , oral contraceptives, TCAs, warfarin à¾ÃÒШзíÒãˌķ¸ÔÂì ÒàËŋҹÕÅé ´Å§ áÅÐäÁ‹¤ÇÃ㪌ÃNj Á¡Ñº SSRIs à¾ÃÒШзíÒãˌà¡Ô´ serotonergic syndrome

37


ÊÃØ»

»¯Ô ¡Ô ÃÔ Â ÒÃÐËNj Ò §ÂÒ/ÂÒ-ÍÒËÒÃ/ÂÒ-ÊÁØ ¹ ä¾Ã ÊÒÁÒö »‡ Í §¡Ñ ¹ 䴌 ⠴¡ÒÃàÍÒã¨ãʋ ã ¹¡ÒÃãˌ ¤í Ò á¹Ð¹í Ò ·Õè ¶Ù ¡ µŒ Í §á¡‹ ¼ÙŒ »† Ç Â àÀÊÑ ª ¡Ã¨ÐµŒ Í §ÊÑ Á ÀÒɳ ¼ÙŒ »† Ç Âà¡Õè Â Ç¡Ñ º ÂÒ ÍÒËÒÃàÊÃÔ Á ÊÁØ ¹ ä¾Ã ·Õè¼ÙŒ»†ÇºÃÔâÀ¤Ã‹ÇÁ¡ÑºÂÒ áÅÐàÀÊѪ¡Ã¨ÐµŒÍ§·ÃÒº¢ŒÍÁÙÅ¡ÒÃà¨çº»†Ç ¼Å¡ÒõÃǨËҧ¡Ò ¼Å¡ÒõÃǨ·Ò§ËŒÍ§»¯ÔºÑµÔ¡ÒÃà¾×èÍ»ÃСͺ¡Òà ãˌ¤íÒ»ÃÖ¡ÉÒ áÅÐàÀÊѪ¡Ã¤ÇÃÁÕ°Ò¹¢ŒÍÁÙÅÂÒ »¯Ô¡ÔÃÔÂÒÃÐËNjҧÂÒ/ ÂÒ ÍÒËÒÃ/ÂÒ-ÊÁعä¾Ã ¡Å؋ Á ¼ÙŒ »† Ç Â¡Å؋ Á àÊÕè  §µ‹ Í ¡ÒÃà¡Ô ´ »¯Ô ¡Ô ÃÔ Â ÒÃÐËNj Ò §ÂÒ/ÂÒ-ÂÒ/ÂÒ-ÍÒËÒ÷Õè µŒ Í §à½‡ Ò ÃÐÇÑ § ໚ ¹ ¾Ô à ÈÉ 1 . ¼ÙŒ»†Ç·Õè໚¹âäàËŋҹÕéÃعáç aplastic anemia, asthma, cardiac arrhythmia, ¼ÙŒ»†ÇÂÇÔ¡ÄµÔ àºÒËÇÒ¹ ÅÁªÑ¡ âäµÑº hypothyroid 2 . ¡Å؋ Á ¼ÙŒ »† Ç Â·Õè ã ªŒ  Òà¾×è Í ÃÑ ¡ ÉÒâä¤ÇÒÁ¤ØŒ Á ¡Ñ ¹ º¡¾Ã‹ Í § âäËÑ Ç ã¨ âä·Ò§à´Ô ¹ ÍÒËÒà âäµÔ ´ àª×é Í âä·Ò§à´Ô¹ËÒÂ㨠âäÅÁªÑ¡ 3 . ¡ÅØÁ‹ ¼Ù»Œ dž ·Õãè ªŒÂÒ low therapeutic index 䴌ᡋ aminoglycoside antibiotics (gentamicin, tobramicin), warfarin, heparins, aspirin, carbamazepine, conjugated estrogen, cyclosporine digoxin, esterified estrogen, hypoglycemic agents, levothyroxine sodium, lithium, phenytoin, procainamide, quinidine sulfate, theophyllin, tricyclic antidepressants, vaproic acid ºÃÃ³Ò¹Ø ¡ ÃÁ Apitz-Castro, R., Escalante, J., Vargas, R., et al. (1986). Ajoene, the antiplatelet principle of garlic, synergistically potentiates the antiaggregatory action of prostacyclin, forskolin, indomethacin, and dipyridamole on human platelets. Thromb Res. 42(3),303-311. Bachmann, A.K., Lewis, D.J., Fuller, A.M., & Bonfiluo, F.M.Drug interaction handbook. 2003. Ohio: Lexi-Comp,Inc. Bordia AK, Joshi JK, Sanadhya YD, et al. (1977). Effect of essential oil of garlic on serum fibrinolytic activity in patients with coronary artery disease. Atheroscl. 28,155-59. Galluzzi, S., Zanetti, O., Binetti, G., Trabucchi, M., Frisoni, G.B. (2000). Coma in a patient with Alzheimer’s disease taking low dose trazodone and Ginkgo biloba. J Neurol Neurosurg Psychiatry. 68,679-83. Miller LC. (1998). Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb nteractions. Arch Intern Med.. 158(9),2200-11. Rosenblatt, M., Mindel, J. (1997) Spontaneous hyphema associated with ingestion of Ginkgo bilboa extract. N Engl J Med. 336,1108-14.. Sikora, R., Sohn, M., Deutz, F.J., et al. (1989). Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol. 141,188A. Shiota, S., Shimizu, M., Mizushima, T., Ito, H., et al. (1999). Marked reduction in the minimum inhibitory concentration (MIC) of B-lactams in methicillin-resistant Staphylococcus aureus produced by epicatechin gallate, an ingredient of green tea (Camellia sinensis). Biol. Pharm. Bull. 22(12),1388-90. Suganuma, M., Okabe, S., Kai Y, Sueoka N, et al.(1999). Synergistic effects of (-)-epigallocatechin gallate with (-)epicatechin, sulindac, or tamoxifen on cancer-preventive activity in the human lung cancer cell line PC-9. Cancer Res. 59,44-47.

38


À¡.»ÃÐÇԷ µÑ¹µÔÊÇØ ·Ô ¡ÅØ ·Õ»è ÃÖ¡ÉÒͧ¤¡ÒþѲ¹Òà·¤â¹âÅÂÕà¾×Íè ¡ÒÃÊÒ¸ÒóÊØ¢ ¡ÃÃÁ¡ÒÃÁÙŹԸáÔ ¾·Âà¾×Íè »ÃЪҪ¹

¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾

ª×è Í ÇÔ · ÂÒÈÒʵÏ Gynostemma pentaphyllum Makino ǧȏ Cucurbitaceae ª×è Í ÀÒÉÒÍÑ § ¡ÄÉ Miracle grass, Southern ginseng (XIANCAO) ª×è Í Í×è ¹ æ »˜­¨¢Ñ¹¸ (ä·Â) «ÒʵÙÅ (ä·Â) ÍÐÁÒ«ÙÃÙ (­Õ»è ¹Ø‹ ) ʋ Ç ¹·Õè ã ªŒ ·Ñ駵Œ¹áÅÐ㺠¶Ôè ¹ ¡í Ò à¹Ô ´ ໚¹¾×ªà¶Ò¾×¹é àÁ×ͧã¹ÀÙÁÀÔ Ò¤à¢µÃŒÍ¹áÅÐࢵͺÍع‹ ¢Í§àÍàªÕµÐÇѹÍÍ¡à©Õ§㵌 áÅÐ ¡ÃШÒ¾ѹ¸Øà »š¹ÊÁعä¾Ã¾×¹é ºŒÒ¹ä»ã¹à¢µÃŒÍ¹áÅÐࢵͺÍع‹ µ‹Ò§æ ¢Í§âÅ¡ à¨ÃÔ­àµÔºâµä´Œ´ãÕ ¹·Õªè Á؋ ª×¹é ·Ñ§é ·Õâè ŋ§á¨Œ§ áÅзÕÃè Á‹ µÑé§áµ‹·ÕèÃÒºµèíÒ¨¹¶Ö§·ÕèÊÙ§¨Ò¡ÃдѺ¹éíÒ·ÐàÅ ÊÒÂ¾Ñ ¹ ¸Ø ẋ § 䴌 à »š ¹ 2 ÊÒÂ¾Ñ ¹ ¸Ø ¤× Í 1. à¨ÕÂÇ¡Ùˌ ÅÒ¹»†Ò໚¹¾×ª·Õ¢è ¹Öé µÒÁ¸ÃÃÁªÒµÔ ÃʪҵԷäÕè ´Œ¨ÐÁÕÃÊ¢Á 2. à¨ÕÂÇ¡Ùˌ ÅÒ¹ºŒÒ¹ ¤×Í »ÅÙ¡µÒÁáËŋ§»ÅÙ¡·ÑÇè ä» ÃʪҵԨÐÁÕÃÊ¢Á »¹ËÇÒ¹ ʋ Ç ¹»ÃСͺ à¨ÕÂÇ¡Ùˌ ÅÒ¹ÁÕÊNj ¹»ÃСͺµ‹Ò§æ ´Ñ§µ‹Í仹Õé ¤×Í 1. Gypenoside 2. Flavonoids 3. ʋǹ»ÃСͺÍ×¹è æ ·Õ¾è ºä´Œàª‹¹à´ÕÂǡѺ·Õ¾è ºã¹âÊÁ 6 ª¹Ô´ áÅФŌÒ¡ѹ¡Ñº·Õ¾è ºã¹âÊÁÍÕ¡ËÅÒª¹Ô´ ઋ¹ Glycoside, Saponin ໚¹µŒ¹ 4. á˸ҵصҋ §æ ઋ¹ «ÕÅàÕ ¹ÕÂÁ áÁ§¡Ò¹ÕÊ ·Í§á´§ à¨ÍÁÒà¹ÕÂÁ àËÅç¡ áÁ¡¹Õà«ÕÂÁ â«à´ÕÂÁ â¾á·Êà«ÕÂÁ «Ô§¤ á¤Åà«ÕÂÁ 5. ¡Ã´ÍÐÁÔ⹠ઋ¹ Arginine, Cystine, Flycine, Lysine, Phenylalanine ໚¹µŒ¹ 6. â»ÃµÕ¹ ¤ÒÏâºäÎà´Ãµ áÅÐä¢Áѹ ¤Ø ³ »ÃÐ⪹ 1. ª‹ÇÂÅ´â¤àÅÊàµÍÃÍŪ¹Ô´ LDL áÅÐÃÑ¡ÉÒ¤ÇÒÁÊÁ´ØÅ㹡ÒÃà¡Ô´¢Í§ä¢Áѹª¹Ô´ HDL ¨Ö§Å´ÊÒà˵ط·Õè Òí ãˌà¡Ô´ ¡ÒÃÍØ´µÑ¹·ÕËè ÅÍ´àÅ×Í´ËÑÇ㨠Ŵ¤ÇÒÁàÊÕÂè §ËÑÇã¨ÇÒÂà©Õº¾Åѹ ª‹Ç·íÒãˌà¡Ô´¡Ãкǹ¡ÒÃà¼Ò¼ÅÒ­ä¢Áѹ䴌´Õ ¨Ö§Å´ä¢Áѹ äÁ‹ãˌÊÐÊÁµÒÁ¼¹Ñ§ËÅÍ´àÅ×Í´ à¹×Íè §¨Ò¡ã¹µÑǢͧà¨ÕÂÇ¡Ùˌ ÅÒ¹ÁÕã¸ÃÃÁªÒµÔ·ÊÕè ÒÁÒö¨Ð´Ù´«Ñº ä¢ÁѹáŌǢѺ¶‹ÒÂÍ͡仨ҡËҧ¡ÒÂ䴌 2. ª‹Ç»ÃѺ¤ÇÒÁÊÁ´ØŢͧÃкº¤ÇÒÁ´Ñ¹âÅËÔµ ઋ¹ ª‹Ç»ÃѺ¡Ò÷íÒ§Ò¹¢Í§ËÑÇã¨ã¹ÊÀÒÇÐà¡Ô´ÃдѺ¤ÇÒÁ´Ñ¹ âÅËÔµµèÒí áÅЪ‹Ç¡ÒâÂÒµÑǢͧËÅÍ´àÅ×Í´àÁ×Íè Ëҧ¡ÒÂÁÕ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ ª‹ÇÂà¾ÔÁè ¤ÇÒÁÊÑÁ¾Ñ¹¸¢Í§¡Òà ·íÒ§Ò¹¢Í§¡ÅŒÒÁà¹×Íé ËÑÇ㨠áÅСÒÃൌ¹¢Í§ËÑÇ㨠ÃÇÁ·Ñ§é »‡Í§¡Ñ¹¡ÒÃà¡ÒеÑǢͧà¡Åç´àÅ×Í´´ŒÇ ¨Ö§ª‹Ç»‡Í§¡Ñ¹ ¡ÒèѺµÑÇ໚¹¡ŒÍ¹¢Í§à¡Åç´àÅ×Í´ ·íÒãˌ»Í‡ §¡Ñ¹¡ÒÃà¡Ô´ÀÒÇÐÍØ´µÑ¹¢Í§ËÅÍ´àÅ×Í´·Õäè »àÅÕÂé §ÊÁͧ䴌 39


3. ª‹Ç¤Ǻ¤ØÁÃдѺ¹éÒí µÒÅã¹àÅ×Í´ ª‹ÇÂÅ´¹éÒí µÒÅã¹àÅ×ʹ䴌 â´Â仡ÃеعŒ ãˌµºÑ ͋͹ËÅѧè ÊÒÃÍÔ¹«ÙÅ¹Ô áÅÐÂѧÂÑ§é ¡Òà ´Ù´«ÖÁ¡ÅÙâ¤Êã¹·Ò§à´Ô¹ÍÒËÒà 4. ª‹ÇªÐÅͤÇÒÁàÊ×èÍÁâ·ÃÁ¢Í§à«Åŏã¹Ã‹Ò§¡Ò à¹×èͧ¨Ò¡ÁÕ Flavonoids, Glycoside ·ÕèÁդسÊÁºÑµÔ㹡ÒõŒÒ¹¡Òà à¡Ô´Í¹ØÁÙÅÍÔÊÃÐ 5. ª‹ÇµŒÒ¹¡ÒÃÍÑ¡àʺ ᡌ»Ç´ »Ç´ÈÕÃÉÐäÁà¡Ã¹ ¢ÑºàÊÁËРᡌäÍ 6. ª‹ÇÂàÊÃÔÁÃкºÀÙÁԤ،Á¡Ñ¹ áÅÐÅ´ÍÒ¡ÒÃᾌ 7. ÃÑ¡ÉÒá¼Å㹡ÃÐà¾ÒÐÍÒËÒà 8. ÂѺÂÑ駡ÒÃàµÔºâµ¢Í§à¹×éͧ͡áÅÐÁÐàÃç§ 9. ª‹Ç¡Ò÷íÒ§Ò¹¢Í§Ãкº¡ÅŒÒÁà¹×éÍËÑÇã¨áÅÐÃкº¡ÒÃäËÅàÇÕ¹¢Í§âÅËÔµ 1 0 . à¾ÔèÁ¤ÇÒÁá¢ç§á¡Ã‹§ãˌ¡Ñºà«Åŏ àÊÃÔÁÊÌҧà«Åŏ䢡Ãд١áÅÐàÁç´àÅ×Í´¢ÒÇ 1 1 . ª‹ÇÂÅ´ÍÒ¡ÒüÁ˧͡ ¼ÁËǧ 1 2 . ª‹ÇÂà¾ÔÁè »ÃÔÁÒ³àª×Íé ÍÊØ¨Ô 1 3 . ÁÕ¡ÒÃÇÔ¨ÂÑ áÅÐÈÖ¡ÉҨҡʶҺѹÇÔ¨ÂÑ ÊÁعä¾Ã ¡ÃÁÇÔ·ÂÒÈÒʵÏ¡ÒÃᾷ NjÒÁÕÄ·¸ÔÂì ºÑ Âѧé enzyme HIV protease ·íÒãˌàª×éÍäÇÃÑÊ HIV äÁ‹à¾ÔèÁ¨íҹǹ¢Öé¹ 1 4 . ÁÕÄ·¸Ôãì ¹¡ÒÃÅ´ÀÒÇСÒÃà¡Ô´¾ÔÉàÃ×Íé Ãѧ·Õµè ºÑ áÅÐÅ´¡ÒÃà¡Ô´ fibrosis â´Â¾ºÇ‹Ò Gypenoside ã¹à¨ÕÂÇ¡Ùˌ ÅÒ¹¨ÐÅ´ ¡ÒÃà¾ÔèÁ¢Ö鹢ͧ SGOT áÅÐ SGPT 䴌ÊÒÁÒö»‡Í§¡Ñ¹ biomembrane ¨Ò¡¡ÒÃà¡Ô´ oxidationinjury 䴌 1 5 . ª‹ÇÂ㹡ÒÃà¾ÔèÁ»ÃÐÊÔ·¸ÔÀÒ¾µ‹Í¡ÒÃÊÑ觧ҹ¢Í§ÊÁͧ ª‹ÇÂÅ´»˜­ËÒ¤ÇÒÁ¨íÒàÊ×èÍÁ䴌 1 6 . ª‹ÇÂ㹡ÒúíÒÃاÊÒÂµÒ 1 7 . ÁÕÊÒê‹ÇºíÒÃاËҧ¡Ò References 1. Chin Med 1993;21(1):59-69 2. ʶҺѹÇÔ¨ÂÑ ÊÁعä¾Ã ¡ÃÁÇÔ·ÂÒÈÒʵÏ¡ÒÃᾷ ¡ÃзÃǧÊÒ¸ÒóÊØ¢ ISBN 974-7549-68-3 ˹ŒÒ 21 3. ˹ѧÊ×;ÔÁ¾ä·ÂÃÑ° àÃ×èͧ¨Õ¹ÃѺÃͧÊÁعä¾Ã»˜­¨¢Ñ¹¸ ©ºÑºÇѹ·Õè 4 ¡ØÁÀҾѹ¸ 2540 40


ÃÈ.´Ã.ÍÃ͹§¤ ¡Ñ§Ê´ÒÅÍíÒä¾

¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾

Nutrition for Oral and Dental Health

âÀª¹Ò¡ÒÃÊíÒËÃѺª‹Í§»Ò¡áÅп˜¹

ÍÒËÒÃÁÕº·ºÒ·ÊíҤѭ㹪‹Í§»Ò¡µÑé§áµ‹¡ÒÃà¨ÃÔ­ áÅСÒþѲ¹Ò¢Í§¿˜¹ ¡Òä§ÊÀÒ¾¢Í§à˧×Í¡áÅÐàÂ×Íè ºØã¹»Ò¡ ¤ÇÒÁá¢ç§áç¢Í§¡Ãд١ áÅСÒäǺ¤ØÁ »‡Í§¡Ñ¹âä㹪‹Í§»Ò¡ ª¹Ô´áÅÐÃٻẺ¢Í§ÍÒËÒÃáÅÐà¤Ã×èͧ´×èÁ ÃÇÁ·Ñ駤ÇÒÁ¶Õè 㹡ÒÃÃѺ»ÃзҹÁÕ¼Åâ´ÂµÃ§µ‹Í¤ÇÒÁ໚¹¡Ã´-àºÊ (pH) áÅСÒÃà¨ÃÔ­¢Í§¨ØŪվ 㹪‹Í§»Ò¡«Öè§Áռŵ‹Í¡Òüآͧ¿˜¹ ÊÒÃÍÒËÒ÷ÕèËҧ¡ÒÂ䴌ÃѺ ઋ¹ ÇÔµÒÁÔ¹ äÃ⺿ÅÒÇÔ¹ â¿àŵ ºÕ12 ÇÔµÒÁÔ¹«Õ ËÃ×ÍáË¸ÒµØ àËÅç¡ áÅÐÊѧ¡ÐÊÕ Áռŵ‹Í¡Òà ¤§ÊÀÒ¾ ¡ÒþѲ¹ÒáÅЫ‹ÍÁá«Á¿˜¹áÅÐà¹×éÍàÂ×èÍ㹪‹Í§»Ò¡ «Öè§ÍÒ¡ÒÃàÃÔèÁáá¢Í§¡Òà ¢Ò´ÊÒÃÍÒËÒùÕé¤×Í¡ÒÃà¡Ô´á¼Å㹪‹Í§»Ò¡ ã¹·Ò§¡ÅѺ¡Ñ¹ÊÀÒ¾¢Í§ª‹Í§»Ò¡¡çÁռŵ‹Í¤ÇÒÁÊÒÁÒö 㹡ÒèÐÃѺ»ÃзҹÍÒËÒÃãˌà¾Õ§¾Í·Ñ§é ã¹´ŒÒ¹»ÃÔÁÒ³áÅФسÀÒ¾ ઋ¹ ¤¹ÍÒÂØà¡Ô¹ 65 »‚ ÁÑ¡ÁÕ»­ ˜ ËÒ¿˜¹ËÅشËǧ «Ö§è Áռŵ‹Í¡ÒÃÃѺ»ÃзҹÍÒËÒà â´Â੾ÒÐãÂÍÒËÒÃáÅÐÍÒËÒÃâ»ÃµÕ¹

ÊÒÃÍÒËÒ÷ÕèÁռŵ‹Í¡ÒÃà¨ÃÔ­áÅоѲ¹Ò¢Í§¿˜¹

¿˜¹Ãع‹ áá¨Ð¾Ñ²¹ÒµÑ§é ᵋÍÒÂØ 2-3 à´×͹㹤ÃÃÀÁÒÃ´Ò á˸ҵصҋ §æ ¨ÐࢌÒÁÒà¡Òеѧé ᵋÍÒÂؤÃÃÀ 4 à´×͹ ¨¹¡ÃзÑè§àÃÔèÁࢌÒÊًÇÑÂÃ؋¹ ´Ñ§¹Ñé¹áÁ‹¤ÇÃ䴌ÃѺÊÒÃÍÒËÒ÷Õèà¡ÕèÂÇ¢ŒÍ§¡Ñº¡ÒþѲ¹Ò¢Í§¿˜¹ãˌà¾Õ§¾Í à¾×èÍ¡ÒÃàÃÔèÁµŒ¹·Õè´Õ ¡ÒâҴÊÒÃÍÒËÒÃÍ‹ҧÃعáçã¹ÃÐËNjҧµÑ§é ¤ÃÃÀ ·íÒãˌ»Ò¡áÅп˜¹·Òá¼Ô´ÃٻËҧ «Ö§è ¨Ð¡‹Íãˌ¿¹˜ ¼Ø䴌§Ò‹ ¢ֹé àÁ×Íè ¿˜¹àÃÔÁè §Í¡ ÍÒËÒÃáÅÐÊÒÃÍÒËÒÃÁռŵ‹Í¡ÒþѲ¹Ò¢Í§¿˜¹á·Œ ÃÇÁ·Ñ§é ¡ÒÃÊÐÊÁáË¸ÒµØ ¡ÒþѲ¹Ò¢Í§à¤Å×ͺ¿˜¹ ¤ÇÒÁá¢ç§áç¢Í§¿˜¹ áÅСÒç͡¢Í§¿˜¹·ÕèàËÅ×Í ¡ÒþѲ¹Ò¢Í§¿˜¹¨ÐàÃÔèÁµŒ¹´ŒÇ¡ÒÃÊÌҧʋǹ¢Í§â»ÃµÕ¹à´¹·Õ¹ (dentin) «Öè§à»š¹¤ÍÅÅÒਹ (collagen) áŌǨ֧ÁÕá˸ҵØÁÒÊÐÊÁ 㹡ÒþѲ¹Ò¢Í§¿˜¹¨Ö§µŒÍ§ÍÒÈÑÂÇÔµÒÁÔ¹«ÕÊíÒËÃѺ¡ÒÃÊÌҧ¤ÍÅÅÒਹ ÇÔµÒÁÔ¹´Õ㹡ÒÃÊÐÊÁ ¢Í§á¤Åà«ÕÂÁáÅпÍÊ¿ÍÃÑÊ໚¹¼ÅÖ¡ã¹ÃÙ»äδÃÍ¡«ÕÍоÒä·· (hydroxyapatite) «Ö§è ¾ºã¹ºÃÔàdzà¤Å×ͺ¿˜¹ (enamel) áÅÐà´¹·Õ¹ ʋǹ¢Í§à¤Å×ͺ¿˜¹ÂѧÁÕâ»ÃµÕ¹à¡ÍÃÒµÔ¹ (keratin) «Ö§è µŒÍ§ÍÒÈÑÂÇÔµÒÁÔ¹àÍ㹡ÒÃÊÌҧ ¢³Ðà´ÕÂǡѹ¿ÅÙÍÍäô (fluoride) ¨ÐࢌÒÁҨѺ໚¹¿ÅÙÍÍâÃÍоÒä·· (fluoroapatite) ·íÒãˌ¿¹˜ á¢ç§á経ҹ¡ÒÃ¼Ø ÍÒËÒÃáÅÐâÀª¹Ò¡ÒÃÁÕº·ºÒ·ÊíҤѭµÅÍ´¡ÒþѲ¹Ò ¡Òç͡áÅСÒä§ÊÀÒ¾¢Í§¿˜¹ ËÅѧ¨Ò¡·Õ¿è ¹˜ §Í¡¢Ö¹é ÁÒ áŌÇÍÒËÒÃÁÕÊNj ¹µ‹Í¡ÒþѲ¹ÒáÅСÒÃÊÐÊÁ¢Í§áË¸ÒµØ ¡ÒþѲ¹ÒáÅФÇÒÁá¢ç§áç¢Í§à¤Å×ͺ¿˜¹ ÍÒËÒ÷ÕÃè ºÑ »Ãзҹ â´Â੾ÒФÒÏâºäÎà´Ãµ·Õ¶è ¡Ù ËÁѡ䴌 (fermentable carbohydrates) áÅФÇÒÁ¶Õãè ¹¡ÒÃÃѺ»ÃзҹÍÒËÒÃÁռŵ‹Í¡Òà ÊÌҧ¡Ã´â´ÂẤ·ÕàÃÕÂ㹪‹Í§»Ò¡áÅСÒüآͧ¿˜¹

45


¡Ãкǹ¡ÒÃà¡Ô´¿˜¹¼Ø (Dental Caries)

¿˜¹¼Øà¡Ô´¨Ò¡¡ÒõԴàª×Íé 㹪‹Í§»Ò¡ ¡Ãкǹ¡Ò÷շè Òí ãˌ¿¹˜ ¼Ø¨ÐàÃÔÁè ¢Ö¹é àÁ×Íè Áաô·Õäè ´Œ¨Ò¡àÁµÒºÍÅÔ«ÁÖ ¢Í§áº¤·ÕàÃÕ ·Õáè ¼‹¹¤ÃÒº¿˜¹ «Ö§è ʋ§¼Åãˌà¡Ô´¡ÒÃÊÅÒÂá¤Åà«ÕÂÁ¨Ò¡¼ÔÇà¤Å×ͺ¿˜¹ ¡Ãкǹ¡Òùըé дíÒà¹Ô¹µ‹Í仨¹¡Ç‹Ò¹éÒí ÅÒ¨ÐÊÒÁÒö ºÑ¿à¿ÍϨ¹¾ÕàͪÊÙ§¡Ç‹Ò 5.5 ¡Ãкǹ¡Òùնé Ҍ »Å‹ÍÂãˌà¡Ô´à»š¹»ÃШíÒ áº¤·ÕàÃÕ¨ÐÊÒÁÒöá·Ã¡¼‹Ò¹à¤Å×ͺ¿˜¹·Õ¶è ¡Ù ÊÅÒ ࢌÒä»ã¹à´¹·Õ¹áÅÐà¹×Íé àÂ×Íè ͋͹¹ØÁ‹ 㹿˜¹ à¡Ô´¡ÒÃÊÅÒÂâ»ÃµÕ¹ã¹â¤Ã§ÊÌҧ¢Í§¿˜¹ ·íÒãˌ¿¹˜ ¼Ø ¡ÒÃà¡Ô´¿˜¹¼Ø¹µÕé ÇÑ ¿˜¹ 䴌ᡋ ʋǹ»ÃСͺ¢Í§à¤Å×ͺ¿˜¹ áÅÐâ»ÃµÕ¹à´¹·Õ¹ µíÒá˹‹§¢Í§¿˜¹ ¨Ø´ËÃ×ͪ‹Í§·ÕÁè ÍÕ ÂÙº‹ ¹¿˜¹ »ÃÔÁÒ³áÅÐʋǹ»ÃСͺ¢Í§¹éíÒÅÒ¨ÐÁÕʋǹÊíҤѭ ¹éíÒÅÒ·Õè໚¹´‹Ò§¨ÐÁռŻ‡Í§¡Ñ¹ ã¹¢³Ðà´ÕÂǡѹ¹éíÒÅÒ·Õè໚¹¡Ã´ ¨Ðà¾ÔèÁâÍ¡ÒÊà¡Ô´¿˜¹¼Ø ¹Í¡¨Ò¡¹ÕéÃٻẺ¡ÒôíÒà¹Ô¹ªÕÇÔµ ¾Ñ¹¸Ø¡ÃÃÁ áÅСÒ÷íÒ¤ÇÒÁÊÐÍÒ´ª‹Í§»Ò¡Áռŵ‹Í¡ÒÃà¡Ô´¿˜¹¼Ø ઋ¹ ºØ¤¤Å·ÕÃè ºÑ »ÃзҹÍÒËÒÃÁ×Íé ÅйŒÍÂæ áÅк‹Í¤Ãѧé á·¹·Õ¨è ÐÃѺ»ÃзҹÍÒËÒÃÇѹÅÐ 2-3 Á×Íé ¨Ðà¾ÔÁè âÍ¡ÒÊãˌ¿¹˜ ÊÑÁ¼ÑÊ ¡Ñº¤ÒÏâºäÎà´Ãµ·ÕËè Áѡ䴌 ·íÒãˌà¾ÔÁè âÍ¡ÒÊ¿˜¹¼ØÁÒ¡¢Ö¹é Ἃ¹¤ÃÒº¿˜¹ (plaque) ໚¹ÁÇŢͧ¨ØÅÔ¹·ÃՏáÅÐâ¾ÅÕ᫤¤Òäô äÁ‹ÁÕÊÕ à¡ÒСѹà˹ÕÂÇÍÂًÃÍºæ ¿˜¹ ໚¹áËŋ§ÊÐÊÁẤ·ÕàÃÕ·ÕÊè ÒÁÒöËÁÑ¡¤ÒÏâºäÎà´Ãµ·íÒãˌà¡Ô´¡Ã´ áÅÐàÁ×Íè ÁÕá͋§à¡Ô´¢Ö¹é ¤ÃÒº¿˜¹¹Õ¨é СѹäÁ‹ãˌ¹Òéí ÅÒ ࢌÒÁҺѿà¿ÍÏ ¢³Ðà´ÕÂǡѹ¤ÃÒº¿˜¹¨Ð¨Ñº¡Ñºá¤Åà«ÕÂÁáÅÐÁÕÅ¡Ñ É³Ðá¢ç§ à¡Ô´à»š¹ËÔ¹»Ù¹ (calculus) Ấ·ÕàÃÕ·ÕÊè ÒÁÒö ËÁÑ¡¤ÒÏâºäÎà´Ãµä´Œà»š¹¡Ã´ ÁÕÊNj ¹ÊíҤѭ·íÒãˌ¿¹˜ ¼Ø ·Õ¾è ºº‹ÍÂ䴌ᡋ Streptococcus mutans ÃͧŧÁÒ䴌ᡋ Lactobacillus casei áÅÐ S. sanguis ÃÐÂÐàÇÅÒ·Õáè º¤·ÕàÃÕÂã¹»Ò¡¨Ðà¡Ô´¡ÒÃËÁÑ¡¤ÒÏâºäÎà´Ãµ¨¹à¡Ô´à»š¹¡Ã´ ·íÒãˌ¾àÕ Íª¢Í§¹éÒí ÅÒÂŴŧ ¶ŒÒ¾Õàͪ µèÒí ¡Ç‹Ò 5.5 Ấ·ÕàÃÕÂã¹»Ò¡¡ç¨ÐàÃÔÁè ¡Ãкǹ¡ÒÃÊÅÒÂá˸ҵØ㹿˜¹ ¾Õàͪ¢Í§á¼‹¹¤ÃÒº¿˜¹ÊÒÁÒöŴŧ䴌ÀÒÂã¹àÇÅÒ 5 ¹Ò·Õ áÅжŒÒäÁ‹ä´Œ·Òí ¤ÇÒÁÊÐÍÒ´¿˜¹¨ÐµŒÍ§ãªŒàÇÅÒ¶Ö§ 2 ªÑÇè âÁ§¡Ç‹Ò¾Õàͪ¨Ð¡ÅѺÁÒ໚¹¡Åҧ䴌 ¤ÒÏâºäÎà´Ãµ·Õ¶è ¡Ù ËÁѡ䴌 (fermentable carbohydrates) 䴌ᡋ ¹éÒí µÒÅáÅÐệ§·Õ¶è ¡Ù ‹ÍÂ䴌´ÇŒ Âà͹ä«ÁÂ͋ Âệ§ (amylase) ã¹¹éÒí ÅÒ ໚¹áËŋ§ÍÒËÒ÷մè ÊÕ Òí ËÃѺàÁµÒºÍÅÔ«ÁÖ ¢Í§áº¤·ÕàÃÕ áŌÇ䴌໚¹¡Ã´ÍÍ¡ÁÒ ·íÒãˌ¾àÕ Íª¢Í§¹éÒí ÅÒ Ŵŧ ·Õ¾è àÕ ÍªµèÒí ¡Ç‹Ò 5.5 ¡Ã´¨ÐàÃÔÁè ÊÅÒÂá˸ҵطàÕè ¤Å×ͺ¿˜¹áÅÐʋǹ»ÃСͺÍ×¹è ¢Í§¿˜¹ ·Õ¾è àÕ ÍªµèÒí ¡Ç‹Ò 5.5 ¨Ö§à»š¹ ÊÀÒÇÐáǴŌÍÁ·Õèʋ§àÊÃÔÁ¡ÒÃà¡Ô´¿˜¹¼Ø ÍÒËÒ÷ÕèÁÕ¤ÒÏâºäÎà´Ãµ¾Ç¡¹Õé䴌ᡋ ¹éíÒµÒÅáÅÐệ§ ¸Ñ­­ÒËÒà ¼ÅäÁŒ ¹Á áÅмÅÔµÀѳ±·àÕè µÔÁ¹éÒí µÒÅ áÅÐÍÒËÒ÷Õàè µÔÁ¹éÒí µÒÅÃÇÁ·Ñ§é ¹éÒí ¼Ö§é ÃÐÂÐàÇÅÒ·Õáè »‡§¨ÐàÃÔÁè ¡Ãкǹ¡Ò÷íÒãˌ¿¹˜ ¼Ø¨Ð¹Ò¹¡Ç‹Ò ¹éÒí µÒÅ à¹×Íè §¨Ò¡á»‡§¨ÐµŒÍ§¶Ù¡Â‹ÍÂâ´Âà͹ä«ÁÂ͋ Âệ§ã¹¹éÒí ÅÒÂãˌ໚¹ÁÍÅâ·Ê¡‹Í¹ áŌÇẤ·ÕàÃÕ¨֧ÁÒËÁÑ¡ÁÍÅâ·Ê ãˌ໚¹¡Ã´ ¹Í¡¨Ò¡¹ÕÊé ‹Ç¹¼ÊÁ¢Í§á»‡§áÅйéÒí µÒÅã¹¢¹Á»˜§ ¸Ñ­­ÒËÒþÌÍÁºÃÔâÀ¤ ¢¹Á»˜§Íº ¨ÐµÔ´ÍÂÙµ‹ ÒÁà¤Å×ͺ ¿˜¹¹Ò¹ ¢¹Á¾Ç¡¹Õ¨é §Ö ·íÒãˌà¡Ô´¿˜¹¼Ø䴌ÁÒ¡¡Ç‹Ò¹éÒí µÒÅ ¹éÒí µÒÅã¹ÍÒËÒÃËÃ×Íà¤Ã×Íè §´×Áè ¨Ð¶Ù¡ªÐÍÍ¡¨Ò¡¿˜¹ä´ŒàÃçǡNjÒệ§ ÃٻẺáÅФÇÒÁ˹״¢Í§ÍÒËÒÃÁռŵ‹Í¡Ò÷íÒãˌà¡Ô´¿˜¹¼Ø ÍÒËÒÃàËÅǨм‹Ò¹¨Ò¡»Ò¡ä»Í‹ҧÃÇ´àÃçÇ ª‹Ç§àÇÅÒ ·ÕèÍÂً㹻ҡ¹ŒÍ 㹢³Ðà´ÕÂǡѹÍÒËÒÃá¢ç§ºÒ§ª¹Ô´ ઋ¹ ¢¹Á»˜§¡Ãͺ ¤Ø¡¡Õé ¼ÅäÁŒ¡Ç¹ ઋ¹ ÁÐÁ‹Ç§¡Ç¹ ¨ÐµÔ´ÍÂÙµ‹ ÒÁ «Í¡¿˜¹¹Ò¹ ËÃ×Í¡ÒÃÍÁÅÙ¡ÍÁ ¹éÒí µÒŨÐÍÂÙ㋠¹»Ò¡¹Ò¹ ʋ§àÊÃÔÁ ãˌà¡Ô´¿˜¹¼Ø ᵋÍÒËÒ÷Õ赌ͧà¤ÕéÂÇ àª‹¹ ËÁÒ¡½ÃÑ觶֧áÁŒ¨ÐÁÕ ¹éÒí µÒÅÊÙ§ ᵋ¢³Ð·Õàè ¤ÕÂé ǨÐÁÕ¹Òéí ÅÒÂÍÍ¡ÁÒ âÍ¡ÒÊ·Õ¹è Òéí µÒŨРÍÂً㹪‹Í§»Ò¡¡çŴŧ ¼ÅäÁŒ ÁÕ ·Ñé § ệ § áÅйéí Ò µÒŠᵋ ¼ ÅäÁŒ ÁÕ Ê‹ Ç ¹·í Ò ãˌ ¿˜¹¼Ø¹ŒÍÂà¹×èͧ¨Ò¡¼ÅäÁŒÁÕ»ÃÔÁÒ³¹éíÒÊÙ§ áÅÐÂѧÁաô«ÔµÃÔ¡ «Ö§è ª‹Ç¡ÃеعŒ ¡ÒÃËÅÑ§è ¹éÒí ÅÒ ¹éÒí µÒÅã¹à¤Ã×Íè §´×Áè áÅйéÒí ¼ÅäÁŒ 46


¨ÐÁռŵ‹Í¿˜¹¼Ø¹ÍŒ ¡NjҢ¹ÁËÇÒ¹ à¹×Íè §¨Ò¡à¤Ã×Íè §´×Áè ¨Ð¶Ù¡ªÐÍÍ¡¨Ò¡»Ò¡ä´ŒÃÇ´àÃçÇ¡Ç‹Ò áµ‹¡Òô×Áè à¤Ã×Íè §´×Áè ·ÕÁè ¹Õ Òéí µÒÅ ÃÐËNjҧÍÒËÒú‹ÍÂæ ËÃ×Í¡ÒèԺà¤Ã×èͧ´×èÁ¹Õéä»àÃ×èÍÂæ ໚¹¡ÒÃ᪋¿˜¹änj¡Ñº¹éíÒµÒÅ ¨Ö§à¾ÔèÁâÍ¡ÒÊ¿˜¹¼Ø䴌ÁÒ¡¢Öé¹ ·íҹͧà´ÕÂǡѹ¡ÒûŋÍÂãˌ·Òá´Ù´¹ÁËÃ×ͧ͢àËÅÇ·ÕèÁÕ¹éíÒµÒÅã¹¢³Ð·Õè¨ÐËÅѺ ·íÒãˌ¢Í§àËÅǹÕéÍÂً㹪‹Í§»Ò¡¹Ò¹ áÅÐã¹¢³Ð·ÕËè ÅѺ¹éÒí ÅÒ¨ÐËÅѧè ÍÍ¡ÁÒ¹ŒÍÂŧ ¡Ãкǹ¡ÒÃÅÐÅÒÂà¤Å×ͺ¿˜¹¨Ö§à¡Ô´¢Ö¹é ·íÒãˌ¿¹˜ ¹éÒí ¹Á¼Ø (Baby Bottle Tooth Decay) ¿˜¹¼Øã¹à´ç¡àÅ硹ըé Ðà¾ÔÁè ¤ÇÒÁàÊÕÂè §µ‹Í¡Òüآͧ¿˜¹á·Œ ´Ñ§¹Ñ¹é ¨Ö§¤ÇÃËÅÕ¡àÅÕÂè §¡ÒÃãˌà´ç¡´Ù´¹Á¡‹Í¹¹Í¹ ¶ŒÒ¨íÒ໚¹¡çãˌ´Ù´¹éíÒá·¹ ʋǹ»ÃСͺÍ×¹è ¢Í§ÍÒËÒÃÁռŵ‹Í¡ÒÃà¡Ô´¿˜¹¼Ø´ÇŒ  ઋ¹ ÍÒËÒùÁáÅмÅÔµÀѳ±¨ÐÁÕá¤Åà«ÕÂÁ áÅпÍÊ¿ÍÃÑÊÊÙ§ ª‹ÇÂ㹡Òúѿà¿ÍϨ§Ö Å´âÍ¡ÒÊà¡Ô´¿˜¹¼Ø ËÃ×ÍàÁÅç´à»Å×Í¡á¢ç§ (nuts) ¶Ö§áÁŒ¨ÐÁÕ¤ÒÏâºäÎà´ÃµÊÙ§ ᵋÁäÕ ¢ÁѹáÅÐãÂÍÒËÒÃÊÙ§ ¨Ö§äÁ‹Á¼Õ Å·íÒãˌ¿¹˜ ¼Ø ÍÒËÒþǡà¹×Íé ÊѵǏ ÍÒËÒ÷ÐàÅ »ÅÒ áÅÐ໚´ä¡‹ ¡çäÁ‹Á¼Õ Å·íÒãˌ¿¹˜ ¼Ø ¤ÇÒÁ¶Õè㹡ÒÃÃѺ»ÃзҹÍÒËÒèÐ໚¹¡ÒÃແ´âÍ¡ÒÊãˌ¡Ã´·ÕèẤ·ÕàÃÕÂÊÌҧ¢Öé¹ÁÒÊÑÁ¼ÑʡѺ¼ÔÇ¿˜¹ ·Ø¡¤ÃÑ駷Õè ÃѺ»ÃзҹÍÒËÒ÷ÕÁè ¤Õ ÒÏâºäÎà´Ãµ·Õ¶è ¡Ù ËÁѡ䴌â´Â¨ØŪվ·íÒãˌ¾àÕ Íªã¹»Ò¡Å´Å§ÀÒÂã¹àÇÅÒ 5-15 ¹Ò·Õ «Ö§è ÁռŷíÒãˌ¿¹˜ ¼Ø ´Ñ§¹Ñ鹡ÒÃÃѺ»ÃзҹÍÒËÒÃËÃ×ͧ͢NjҧËÅÒÂæ Á×éÍ ¡ç¨Ðà¾ÔèÁâÍ¡ÒÊà¡Ô´¿˜¹¼Ø䴌ÁÒ¡¡Ç‹Ò¡ÒÃÃѺ»ÃзҹÍÒËÒà 3 Á×éÍ ¡ÒÃÃѺ»Ãзҹ¢¹Á¡Ô¹àŋ¹ ËÃ×ͤء¡Õéà¾Õ§¤ÃÑé§à´ÕÂÇ áŌÇá»Ã§¿˜¹ËÃ×ͺŒÇ¹»Ò¡¨ÐÅ´âÍ¡ÒÊà¡Ô´¿˜¹¼Ø䴌ÁÒ¡¡Ç‹Ò ¡ÒÃÃѺ»Ãзҹä»àÃ×Íè Âæ ·Ñ§é Çѹ ¹éíÒÅÒ¨Ъ‹ÇªÐŌҧÍÒËÒ÷ÕèµÔ´¿˜¹ ¢³Ðà´ÕÂǡѹ¹éíÒÅÒ·íÒ˹ŒÒ·Õè໚¹ºÑ¿à¿ÍϪ‹Ç·íÒãˌ¡Ã´·Õèà¡Ô´¨Ò¡ àÁµÒºÍÅÔ«ÁÖ ¢Í§áº¤·ÕàÃÕÂ໚¹¡ÅÒ§ ¡ÒÃà¤ÕÂé ǨЪ‹Ç¡ÃеعŒ ¡ÒÃËÅÑ§è ¹éÒí ÅÒ¨֧ª‹ÇÂÅ´¿˜¹¼Ø䴌 ¹éÒí ÅÒÂÂѧÍØ´Á´ŒÇÂá¤Åà«ÕÂÁ áÅпÍÊ¿ÍÃÑʨ֧ª‹ÇÂ㹡ÒÃàÊÃÔÁá˸ҵءÅѺࢌÒä»ã¹¿˜¹ ¶ŒÒ¹éíÒÅÒÂÁÕ¿ÅÙÍÍäô¡ç¨Ð仨Ѻ¡Ñºá¤Åà«ÕÂÁ㹿˜¹ÍÂًã¹ÃÙ» fluoroapatite «Ö§è ª‹ÇÂãˌ¿¹˜ á¢ç§áçÂÔ§è ¢Ö¹é ¿ÅÙ Í Íäô à »š ¹ ÊÒõŒ Ò ¹¿˜ ¹ ¼Ø ÍҨ䴌 ÃÑ º â´Â¡ÒÃÃÑ º »Ãзҹ ËÃ× Í ãˌ ⠴µç·Õè ¿˜ ¹ ÁÕ ¤ ÇÒÁ»ÅÍ´ÀÑ Â áÅÐÁÕ»ÃÐÊÔ·¸ÔÀҾ㹡ÒÃÅ´¡ÒÃà¡Ô´¿˜¹¼Ø ¡ÒÃ㪌¿ÅÙÍÍäôã¹¡Òû‡Í§¡Ñ¹¿˜¹¼ØÍÒ¨ãˌã¹ÃÙ»¹éíÒ´×èÁàÊÃÔÁ¿ÅÙÍÍäô ÂÒÊÕ¿˜¹àÊÃÔÁ¿ÅÙÍÍäô ¹éíÒÂÒºŒÇ¹»Ò¡ áÅÐÂÒÊÕ¿˜¹ ¤ÇÒÁࢌÁ¢Œ¹ÊÙ§Êش㹡ÒÃàÊÃÔÁ¿ÅÙÍÍäôã¹¹éíÒ´×èÁÍÂً·Õè 0.7-1.2 ʋǹã¹ÅŒÒ¹Ê‹Ç¹ «Ö§è ໚¹¤ÇÒÁࢌÁ¢Œ¹·ÕÊè ÒÁÒö»‡Í§¡Ñ¹¿˜¹¼Ø䴌 â´ÂäÁ‹·Òí ãˌà¡Ô´ÃÍ´‹Ò§º¹¿˜¹ »˜¨¨Øº¹Ñ äÁ‹á¹Ð¹íÒãˌàÊÃÔÁ¿ÅÙÍÍäôá¡‹·ÒáµÑ§é ᵋááà¡Ô´¶Ö§ 6 à´×͹ ËÅѧ¨Ò¡ 6 à´×͹¶Ö§ 3 ¢Çº ¨ÐàÊÃÔÁ¿ÅÙÍÍäô 㹡óշ¹Õè Òéí ´×Áè ÁÕ¿ÅÙÍÍäôµÒèí ¡Ç‹Ò 0.3 Á¡. µ‹ÍÅԵà ·Ñ§é ¹Õàé ¹×Íè §¨Ò¡à´ç¡¨Ðä´ŒÃºÑ ¿ÅÙÍÍäô¨Ò¡ÍÒËÒÃáÅйéÒí ËÃ×Í¡ÒáÅ×¹ ¼ÅÔµÀѳ±·àÕè ¡ÕÂè Ç¢ŒÍ§¡Ñº¡ÒôÙáÅ¿˜¹ «Ö§è ¨Ð¾ºÇ‹Òà´ç¡ä´ŒÃºÑ ¿ÅÙÍÍäôÁÒ¡áÅоºÀÒÇпÅÙÍÍäôà¡Ô¹ (fluorosis) ã¹à´ç¡ÁÒ¡¢Ö¹é ÀÒÇпÅÙ Í Íäô à ¡Ô ¹ ໚ ¹ ¼Å¨Ò¡¡ÒÃ䴌 ÃÑ º ¿ÅÙ Í Íäô Á Ò¡à¡Ô ¹ «Öè § ÍҨ䴌 ÃÑ º ¨Ò¡ÍÒËÒÃËÃ× Í ¨Ò¡¡ÒÃàÊÃÔ Á ઋ ¹ ¡ÒÃà¤Å× Í º¿ÅÙ Í Íäô ËÃ× Í ¨Ò¡¡ÒáÅ× ¹ ÂÒÊÕ ¿˜ ¹ ËÃ× Í ¹éí Ò ÂÒºŒ Ç ¹»Ò¡·Õè ¼ ÊÁ¿ÅÙ Í Íäô ã ¹ª‹ Ç §·Õè ¿˜ ¹ ¡í Ò ÅÑ § ¨Ð§Í¡ ã¹ÃÐÂÐàÃÔèÁáá¢Í§¡ÒÃ䴌ÃѺ¿ÅÙÍÍäôÁÒ¡à¡Ô¹¨Ðà¡Ô´à»š¹¨Ø´ÊÕ¢ÒÇ໚¹Ë‹ÍÁæ ¶ŒÒÂѧ¤§ä´ŒÃѺ¿ÅÙÍÍäôÁÒ¡à¡Ô¹ ¡ç¨Ðà¡Ô´à»š¹ÃÍÂÊÕ¹éíÒµÒÅࢌÁº¹¿˜¹ (¿˜¹µ¡¡ÃÐ) ¿˜¹¨Ðá¢ç§áµ‹à»ÃÒзíÒãˌâÍ¡ÒÊà¡Ô´»š¹ÃÙº¹¼ÔǢͧà¤Å×ͺ¿˜¹ ·íÒãˌ໚¹¨Ø´Í‹Í¹·Õ¨è мØ䴌§Ò‹  ã¹à´ç¡ÍÒÂصÒèí ¡Ç‹Ò 6 ¢Çº ¾‹ÍáÁ‹¤ÇÃàÍÒã¨ãʋ´áÙ Åãˌṋã¨Ç‹Òà´ç¡ä´ŒÃºÑ ¿ÅÙÍÍäôà¾Õ§¾Í ÊíÒËÃѺ¡ÒþѲ¹Ò¢Í§¿˜¹ ¢³Ðà´ÕÂǡѹ¡çäÁ‹ä´ŒÃºÑ ÁÒ¡à¡Ô¹ ºÃÃ³Ò¹Ø ¡ ÃÁ Radler D.G. and Riva Touger-Decker. Nutrition for Oral and Dental Health. Eds. Mahan L.K. and Sylvia Escott-Stump. Krause’s Food and Nutrition Therapy. 12th ed. Saunders Elsevier, Canada. 2008;636-651

47


º·¤ÇÒÁ CPE

À¡.´Ã.ÇÔÇÃø¹ ÍѤÃÇÔàªÕÂÃ

ÇÑ µ ¶Ø » ÃÐʧ¤ 1. ÃкØ䴌NjÒ㹡óÕã´·Õè¼ÙŒ»†ÇÂÊÁ¤ÇÃ䴌ÃѺÂÒµŒÒ¹äÇÃÑÊ䢌ËÇÑ´ãË­‹ 2. ÃкØẺἹ¡ÒÃãˌÂÒÊíÒËÃѺÂÒµŒÒ¹äÇÃÑÊ䢌ËÇÑ´ãË­‹ 3. ÃкØ䴌NjҡÒÃ㪌ÂÒµŒÒ¹äÇÃÑÊ䢌ËÇÑ´ãË­‹ÍÒ¨¡‹Í¼ÅäÁ‹¾Ö§»ÃÐʧ¤ã´ºŒÒ§

º·¹íÒ

äÇÃÑÊ䢌ËÇÑ´ãË­‹¹Ñé¹ÁÕËÅÒÂÊÒ¾ѹ¸Ø äÇÃÑÊ䢌ËÇÑ´ãË­‹â´ÂʋǹÁÒ¡ÁÑ¡¨Ð¡‹Íãˌà¡Ô´âä·ÕèàÃÕÂ¡Ç‹Ò ä¢ŒËÇÑ´ãË­‹ µÒÁÄ´Ù¡ÒŠᵋ¡Áç äÕ ÇÃÑʺҧÊÒ¾ѹ¸Ø· ÁÕè ¡Õ Í‹ ãˌà¡Ô´âä·ÕÃè ¹Ø áçáÅÐÁÕ¡ÒÃÃкҴã¹Ç§¡ÇŒÒ§ ¡ÒÃÃкҴ¢Í§âä䢌ËÇÑ´ãË­‹ ·Õàè »š¹¡ÒÃÃкҴÃعáçã¹Ç§¡ÇŒÒ§ã¹ª‹Ç§ÈµÇÃÃÉ·Õ¼è ҋ ¹ÁÒ·ÕÊè Òí ¤Ñ­æ ¤×Í ¡ÒÃÃкҴ㹻‚ ¤.È.1918 »‚ ¤.È.1957 áÅÐ »‚ ¤.È.1968 «Ö§è ÁÕ¼¤ÙŒ ¹ÅŒÁµÒÂ໚¹¨íҹǹÁÒ¡à¹×Íè §¨Ò¡äÁ‹ÊÒÁÒöàµÃÕÂÁ¡ÒÃã¹àÃ×Íè §ÇѤ«Õ¹ä´Œ·¹Ñ áÅÐäÁ‹ÁÂÕ ÒµŒÒ¹äÇÃÑÊ·Õãè ªŒä´Œ¼Å 㹪‹Ç§àÇÅҹѹé ã¹»‚ ¤.È.2006 䴌à¡Ô´¡ÒÃÃкҴ¢Í§äÇÃÑÊ H5N1 ã¹ÊѵǏ»¡‚ «Ö§è àª×Íé ÊÒÁÒöá¾Ã‹¡ÃШÒ¨ҡÊѵǏ»¡‚ ÊÙ¤‹ ¹ä´Œ (·Õàè ÃÕ¡NjÒ䢌ËÇÑ´¹¡) ᵋ·Ç‹Ò¡ÒÃÁÕÁҵáÒèѴ¡Òõ‹Ò§æ ·ÕÃè Ç´àÃçǷѹ·‹Ç§·Õ áÅСÒÃÁÕÂÒµŒÒ¹äÇÃÑÊ·ÕÊè ÒÁÒöÂѺÂѧé àª×éÍ H5N1 ·íÒãˌÊÒÁÒö¤Çº¤ØÁ¤ÇÒÁÃعáç¨Ò¡âä䴌 áÅÐàÁ×è͵Œ¹»‚ ¤.È.2009 ¡ç¡ÅѺÁÕ¡ÒÃÃкҴã¹Ç§¡ÇŒÒ§¢Í§ 䢌ËÇÑ´ãË­‹«Öè§ÁÕµŒ¹à˵ØÁÒ¨Ò¡äÇÃÑÊ Influenza A ÊÒ¾ѹ¸Ø H1N1 «Öè§àÃÕ¡ª×èÍNjÒ໚¹ 䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ᵋ¹ºÑ NjÒ⪤´Õ·ÁÕè ÂÕ Ò·Õãè ªŒÂºÑ Âѧé äÇÃÑÊ H1N1 䴌¼Å ÃÇÁ·Ñ§é ÁÕ¤ÇÒÁ¾ÂÒÂÒÁà˧¡ÒüÅÔµÇѤ«Õ¹ÍÍ¡ÁÒ㪌 à¾×Íè ÊÌҧ¤ÇÒÁࢌÒ㨠ãˌà¡Ô´¡ÒÃ㪌ÂÒ䴌Í‹ҧ¶Ù¡µŒÍ§ÊÁà˵ØÊÁ¼Å (rational drug use) º·¤ÇÒÁ¹Õ¶é ¡Ù à¢Õ¹¢Ö¹é à¾×Íè ãˌàÀÊѪ¡ÃªØÁª¹ä´Œ·º·Ç¹ áÅÐàÃÕ¹ÃٌàÃ×èͧÂÒµŒÒ¹äÇÃÑÊÊíÒËÃѺ¡ÒÃÃÑ¡ÉÒ䢌ËÇÑ´ãË­‹ã¹ÊÒÃÐÊíҤѭà¾×èÍ¡Òû¯ÔºÑµÔ·ÕèàËÁÒÐÊÁ

äÇÃÑÊ䢌ËÇÑ´ãË­‹

àª×éÍ·Õè໚¹µŒ¹à˵ØáÅСÒÃá¾Ã‹¢Í§àª×éÍ äÇÃÑÊ䢌ËÇÑ´ãË­‹à»š¹ RNA virus ¡ÅØÁ‹ orthomyxovirus «Ö§è ÁÕ 2 ª¹Ô´ ¤×Í Influenza A áÅÐ Influenza B ·Õ¼è ÇÔ ¢Í§äÇÃÑʹըé ÐÁÕâ»ÃµÕ¹·ÕÊè Òí ¤Ñ­ 2 ª¹Ô´¤×Í Hemagglutinin (HA) áÅÐ Neuraminidase (NA) ¡ÒÃàÃÕ¡ª×Íè ÊÒ¾ѹ¸Ø¢ ͧäÇÃÑʨ֧àÃÕ¡µÒÁª¹Ô´¢Í§ HA áÅÐ NA ·Õµè ÃǨ¾º ઋ¹ H1N1, H5N1, H5N5 ÏÅÏ

48


ÃÙ » ·Õè 1 áÊ´§¢Ñé ¹ µÍ¹¡ÒÃµÔ ´ áÅÐá¾Ã‹ à ª×é Í äÇÃÑ Ê ã¹à«Åŏ (ÃÙ » ¨Ò¡ Beigel & Bray 2007)

ÃÙ»·Õè 1 áÊ´§¡ÒÃá¾Ã‹¾¹Ñ ¸Ø¢ ͧäÇÃÑÊ䢌ËÇÑ´ãË­‹ «Ö§è ÁÕ 7 ¢Ñ¹é µÍ¹ÊíҤѭ ¤×Í 1.¡ÒèѺà¡ÒСѺà«Åŏ (binding) 2.¡ÒÃËÅÍÁÃÇÁ¡Ñ¹áÅСÒäÅÕÍè Í¡¢Í§ÃËÑʾѹ¸Ø¡ÃÃÁ (fusion and uncoating) 3.¡ÒÃà¤Å×Íè ¹ÊÒÂÃËÑʾѹ¸Ø¡ÃÃÁࢌҹÔÇà¤ÅÕÂÊ (nucleoprotein migration into nucleus) 4.¡ÒäѴÅÍ¡áÅзíÒ«éÒí ÃËÑÊ RNA (transcription and genome replication) 5.¶Í´ÃËÑÊ໚¹ÊÒ¾ѹ¸Ø¡ÃÃÁÊÒÂãËÁ‹ (translation) 6.¡ÒûÃСͺ໚¹äÇÃÑʵÑÇãËÁ‹ (assembly) 7.¡ÒûŴ»Å‹Í ໚¹äÇÃÑʵÑÇãËÁ‹ (release) µíÒá˹‹§áÅСÅä¡¡ÒÃÍÍ¡Ä·¸Ôì¢Í§ÂÒ ÂÒ·Õè㪌㹡ÒÃÂѺÂÑ駡ÒÃá¾Ã‹¾Ñ¹¸Ø¢Í§äÇÃÑÊ䢌ËÇÑ´ãË­‹·ÕèÁÕ㪌㹻˜¨¨ØºÑ¹ ÁÕµÒí á˹‹§¡ÒÃÍÍ¡Ä·¸ÔÍì ÂÙ·‹ ÊÕè ͧ¢Ñ¹é µÍ¹ ¤×Í 1 . ÂѺÂÑ駡Ò÷íÒ§Ò¹¢Í§ M2 protein à¾ÃÒÐàÃÒÁÕ¤ÇÒÁÃٌ·ÕèNjҢÑ鹵͹ uncoating ¢Í§äÇÃÑÊ Influenza A ¨íÒ໚¹µŒÍ§ÁÕ¡ÒáÃеعŒ ion channel «Ö§è ໚¹â»ÃµÕ¹·ÕÁè ªÕ Íè× Ç‹Ò M2 protein ¡‹Í¹¨Ö§¨Ðà¡Ô´¡Ãкǹ¡ÒöѴæ ÁÒ䴌 ¶ŒÒËÒ¡ M2 protein ¶Ù¡ÂѺÂÑ§é ¡ç¨ÐäÁ‹à¡Ô´¡ÒäѴÅÍ¡áÅзíÒ«éÒí ÃËÑÊ RNA áÅÐäÁ‹à¡Ô´¡ÒöʹÃËÑÊ໚¹ÊÒ¾ѹ¸Ø¡ÃÃÁÊÒÂãËÁ‹ 2 . ÂѺÂÑ§é ¡Ò÷íÒ§Ò¹¢Í§à͹ä«Á neuraminidase à¹×Íè §¨Ò¡¢Ñ¹é µÍ¹¡ÒûŴ»Å‹ÍÂÍÍ¡ÁÒ໚¹äÇÃÑʵÑÇãËÁ‹·§Ñé ¢Í§ Influenza A áÅÐ Influenza B ¨íÒ໚¹µŒÍ§ÁÕà͹ä«Á neuraminidase à¾×Íè äÁ‹ãˌäÇÃÑʨÐà¡ÒСѹ໚¹¡ÅØÁ‹ ¡ŒÍ¹ Áԩйѹé Áѹ¨Ð äÁ‹ÁդسÊÁºÑµÔ·Õè¨Ðä»·íÒãˌà«Åŏ·Ò§à´Ô¹ËÒÂ㨵Դàª×éÍ䴌

ÂÒ·Õè㪌ÊíÒËÃѺÂѺÂÑé§àª×éÍäÇÃÑÊ䢌ËÇÑ´ãË­‹

ÂÒ·Õäè ´ŒÃºÑ ¡ÒþÔʨ٠¹áŌÇNjÒÁÕ¼Å㹡ÒÃÂѺÂѧé M2 protein ¢Í§äÇÃÑÊ Influenza A áÅÐÁÕ»ÃÐ⪹ã¹¡ÒÃÃÑ¡ÉÒ ¡ÒõԴàª×Íé ¤×Í Amantadine áÅÐ Rimantadine áÅÐÂÒ·ÕÂè ºÑ ÂÑ§é ¡Ò÷íÒ§Ò¹¢Í§à͹ä«Á neuraminidase áÅÐÁÕ»ÃÐ⪹ 㹡ÒÃÃÑ¡ÉÒ¡ÒõԴàª×Íé Influenza A áÅÐ B ¤×Í Zanamivir áÅÐ Oseltamivir ʋǹÂÒ Peramivir ¡íÒÅѧÍÂÙ㋠¹¢Ñ¹é µÍ¹¡ÒÃÈÖ¡ÉÒ ¼Åã¹·Ò§¤ÅÔ¹¡Ô ÍÂً »ÃÐÊÔ·¸ÔÀÒ¾áÅФÇÒÁ»ÅÍ´ÀÑ¢ͧÂÒ Amantadine áÅÐ Rimantadine 㪌䴌¼Å¡Ñº Influenza A ෋ҹÑé¹ Ê‹Ç¹ Neuraminidase inhibitor 㪌䴌¼Å¡Ñº·Ñ§é Influenza A áÅÐ B ÁÕ¡ÒÃÇÔ¨ÂÑ ÁÒ¡ÁÒ·ÕÈè ¡Ö ÉÒ¶Ö§»ÃÐÊÔ·¸ÔÀÒ¾¢Í§¡Òà 㪌ÂÒà¾×Íè ÃÑ¡ÉÒ䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒŠᵋ¡ÒÃÈÖ¡ÉÒ·Õàè »š¹ clinical trial áÅÐãˌ¼Å·Õàè ª×Íè ¶×Í䴌 ÊÃػ䴌´§Ñ µÒÃÒ§·Õè 1 Oseltamivir ÁÕ»ÃÐÊÔ·¸ÔÀÒ¾´Õ㹡ÒÃÃÑ¡ÉÒ¡ÒõԴàª×Íé 䢌ËÇÑ´¹¡ (H5N1) áÅÐÂѧÁբ͌ ÁÙÅáÊ´§»ÃÐÊÔ·¸ÔÀҾ㹡Òà »‡Í§¡Ñ¹ä¢ŒËÇÑ´¹¡ÍÕ¡´ŒÇ ÊíÒËÃѺ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ 2009 ÂÒ·Õáè ¹Ð¹íÒãˌàÅ×Í¡ãªŒÍ¹Ñ ´Ñºáá¤×Í Oseltamivir ઋ¹¡Ñ¹ ʋǹ»ÃÐÊÔ·¸ÔÀÒ¾¢Í§ÂÒ¨Ð໚¹Í‹ҧäÃÂѧµŒÍ§ÃÍ¡ÒÃà¡çº¢ŒÍÁÙÅÁÒÇÔà¤ÃÒÐˏà¹×èͧ¨Ò¡âä¹Õéà¾Ôè§ÃкҴàÁ×èÍ»ÃÐÁÒ³ µŒ¹»‚ ¤.È.2009 49


µÒÃÒ§·Õè 1 áÊ´§¼Å¡ÒÃÈÖ ¡ ÉÒ»ÃÐÊÔ · ¸Ô À Ò¾¢Í§ÂÒÂÑ º ÂÑé § äÇÃÑ Ê ä¢Œ Ë ÇÑ ´ ãË­‹ µ ÒÁÄ´Ù ¡ ÒÅ (¨Ò¡ÊÃØ » ¡ÒÃÈÖ ¡ ÉҢͧ Stiver 2003) ÂÒáÅТ¹Ò´

ÅÑ ¡ ɳСÒû† Ç Â

Amantadine ËÃ×Í Rimantadine 200 Á¡. ÇѹÅФÃѧé Inhaled Zanamivir 10 Á¡. ÇѹÅÐ 2 ¤Ãѧé Inhaled Zanamivir 10 Á¡. ÇѹÅÐ 2 ¤Ãѧé Inhaled Zanamivir 10 Á¡. ÇѹÅÐ 2 ¤Ãѧé

䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅ ã¹ÍÒÊÒÊÁѤà 䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅ ã¹¼Ù·Œ ÊÕè ¢Ø ÀÒ¾´ÕÁÒ¡‹Í¹ 䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅ ã¹¼Ù·Œ ÁÕè ¤Õ ÇÒÁàÊÕÂè §ÊÙ§* 䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅ ã¹¼Ù»Œ dž ÂâäËͺ áÅÐ COPD 䢌ËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅ ã¹¼Ù·Œ ÊÕè ¢Ø ÀÒ¾´ÕÁÒ¡‹Í¹

Oseltamivir 75 Á¡. ÇѹÅÐ 2 ¤Ãѧé

ª¹Ô ´ ¢Í§ 䢌 Ë ÇÑ ´ ãË­‹

Median reduction ¢Í§ àÇÅÒ·Õè ¨ СÅÑ º Êً ÀÒÇл¡µÔ à ·Õ Â º ¡Ñ º placebo 1.5 Çѹ

¡ÒÃÅ´ÀÒÇÐ á·Ã¡«Œ Í ¹

A

Median reduction ¢Í§ ÇÑ ¹ ·Õè á Ê´§ÍÒ¡Òà »† Ç Âà·Õ  º¡Ñ º placebo 1.0-1.6 Çѹ

A áÅÐ B

1.5-2.5 Çѹ

1.0-2.0 Çѹ

33-70%

A áÅÐ B

2.5 Çѹ

3.0 Çѹ

43%

A áÅÐ B

1.5 Çѹ

äÁ‹ä´ŒÃÒ§ҹ

58%

A áÅÐ B

1.3 Çѹ

1.4-2.9 Çѹ

50%

äÁ‹ä´ŒÃÒ§ҹ

ËÁÒÂà赯 * ¼ÙŒ·Õè໚¹¼ÙŒ»†Ç¤ÇÒÁàÊÕè§ÊÙ§ ¤×Í ¼ÙŒ»†ÇÂâäËÑÇã¨ÇÒÂàÃ×éÍÃѧ ¼ÙŒ»†ÇÂâÃ¤äµ ¼ÙŒ»†ÇÂâäµÑº ¼ÙŒ»†ÇÂàºÒËÇÒ¹ ¼ÙŒ»†Ç COPD

50

ÊíÒËÃѺ¼ÅäÁ‹¾§Ö »ÃÐʧ¤¢Í§ÂÒ ÁÕÃÒÂ§Ò¹Ç‹Ò Amantadine ·íÒãˌà¡Ô´ÁÖ¹§§ ¤Å×¹è äʌ ¹Í¹äÁ‹ËÅѺ ã¹¼Ù·Œ ãÕè ªŒÂÒ ¹Õ¶é §Ö »ÃÐÁÒ³ 15% ÂÒ¹Õ¡é Òí ¨Ñ´·Ò§äµ ¨Ö§µŒÍ§ãˌ¤ÇÒÁãʋã¨ã¹¡ÒûÃѺ¢¹Ò´ã¹¼Ù»Œ dž ÂÊÙ§ÍÒÂØ áÅмٻŒ dž ÂâÃ¤äµ Oseltamivir ¡‹Íãˌà¡Ô´ÍÒ¡ÒäÅ×¹è äʌ ÍÒà¨Õ¹ »Ç´·ŒÍ§ »Ç´ÈÕÃÉÐ䴌»ÃÐÁÒ³ 7% áÅÐÁÕÃÒ§ҹNjҼٷŒ ãÕè ªŒÂÒ oseltamivir áÊ´§ÍÒ¡Ò÷Õàè »š¹¤ÇÒÁ¼Ô´»¡µÔ·Ò§¨Ôµ»ÃÐÊÒ· ઋ¹ à¡Ô´ÀÒ¾ËÅ͹ ·íÒÌÒµÑÇàͧ ÃÇÁ¶Ö§·íÒÍѵµÇÔºÒ¡¡ÃÃÁ â´Â੾ÒÐã¹¼Ù»Œ dž ÂÇÑÂÃع‹ Zanamivir ໚¹ÃٻẺÂÒ¾‹¹¨ÁÙ¡ «Öè§ÍÒ¨¡‹Íãˌà¡Ô´¼ÅäÁ‹¾Ö§»ÃÐʧ¤ã¹àÃ×èͧ¡ÒÃÃФÒÂà¤×ͧ·Ò§à´Ô¹ËÒÂ㨠áÅÐà¤ÂÁÕÃÒ§ҹNjÒÂÒà˹ÕÂè ǹíÒãˌà¡Ô´¡ÒÃËͺ »˜ ­ ËÒ¡Òô×é Í ÂÒ ¡Òô×éÍÂÒ¡Å؋Á M2 protein inhibitor à¡Ô´ä´Œ§‹Ò¡NjҡÒô×éÍ¡Å؋Á Neuramnidase inhibitor Í‹ҧäáçµÒÁ 䴌ÁÃÕ Ò§ҹ¡Òô×Íé ÂÒ Oseltamivir ¢Í§àª×Íé H5N1 áÅÐ àª×Íé H1N1 à¡Ô´¢Ö¹é áŌǷѧé 㹷ҧˌͧ»¯ÔºµÑ ¡Ô ÒÃáÅÐã¹·Ò§¤ÅÔ¹¡Ô ´Ñ§¹Ñ¹é ¨Ö§µŒÍ§ÁÕÁҵáÒ÷Õàè ¢ŒÁ§Ç´¡Ñº¡ÒÃ㪌 Oseltamivir áÅÐäÁ‹¤ÇÃ㪌ÂÒ¹Õàé ¾×Íè ¡Òû‡Í§¡Ñ¹ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ 2009 à¹×Íè §¨Ò¡ËÒ¡à¡Ô´»˜­ËÒ´×Íé ÂÒ¢Ö¹é ¨Ð·íÒãˌäÁ‹ÁÂÕ Ò·Õãè ªŒà¾×Íè ¡ÒÃÃÑ¡ÉÒÍÕ¡µ‹Íä» ¢Œ Í º‹ § 㪌 áÅТ¹Ò´¡ÒÃ㪌 ¢ ͧÂÒ áÁŒÇ‹Ò Amantadine 䴌ÃѺãˌ¢Öé¹·ÐàºÕ¹㹢ŒÍº‹§ãªŒà¾×èÍ»‡Í§¡Ñ¹ Influenza A 䴌´ŒÇÂáÅÐ Oseltamivir ¡ç䴌ÃѺãˌ¢Öé¹·ÐàºÕ¹NjÒÊÒÁÒö㪌à¾×èÍ»‡Í§¡Ñ¹ Influenza A áÅÐ B 䴌 ᵋ¡ÒÃÈÖ¡ÉÒ·Ò§àÀÊѪàÈÃÉ°ÈÒʵÏ ªÕãé ˌàËç¹Ç‹Ò¡ÒÃãªŒÇ¤Ñ «Õ¹¨ÐÁÕ¤ÇÒÁ¤ØÁŒ ã¹á§‹àÈÃÉ°ÈÒʵÏÁÒ¡¡Ç‹Ò ´Ñ§¹Ñ¹é ÂÒàËÅ‹Ò¹Õ¨é §Ö ¤ÇÃ㪌à¾×Íè ¡ÒÃÃÑ¡ÉÒÁÒ¡¡Ç‹Ò໚¹¡Òà 㪌à¾×Íè ¡Òû‡Í§¡Ñ¹ ¡Å‹ÒǤ×ͨÐÁբ͌ º‹§ãªŒÊÒí ËÃѺ 1 . ¼Ù»Œ dž ·ÕÁè ÀÕ ÒÇÐÀÙÁ¤Ô Á، ¡Ñ¹º¡¾Ã‹Í§·Õáè Ê´§ÍÒ¡Òâͧ¡ÒÃ໚¹ä¢ŒËÇÑ´ãË­‹ áÁŒ¨Ð໚¹¼Ù·Œ àÕè ¤Âä´ŒÃºÑ ÇѤ«Õ¹ÁÒáÅŒÇ 2 . ¼Ù»Œ dž ·Õãè ªŒÂÒ·ÕÁè ÄÕ ·¸Ô¡ì ´ÀÙÁ¤Ô Á، ¡Ñ¹·Õáè Ê´§ÍÒ¡Òâͧ¡ÒÃ໚¹ä¢ŒËÇÑ´ãË­‹ áÁŒ¨Ð໚¹¼Ù·Œ àÕè ¤Âä´ŒÃºÑ ÇѤ«Õ¹ÁÒáÅŒÇ 3 . ¼ÙŒÊÙ§ÍÒÂØ·ÕèáÊ´§ÍÒ¡Òâͧ¡ÒÃ໚¹ä¢ŒËÇÑ´ãË­‹ áÁŒ¨Ð໚¹¼ÙŒ·Õèà¤Â䴌ÃѺÇѤ«Õ¹ÁÒáÅŒÇ 4 . ¼Ù·Œ áÕè Ê´§ÍÒ¡Òâͧ¡ÒÃ໚¹ä¢ŒËÇÑ´ãË­‹ áÁŒ¨Ðà¤Âä´ŒÃºÑ ÇѤ«Õ¹ÁÒáÅŒÇ áµ‹à»š¹ÇѤ«Õ¹ÊíÒËÃѺ¤¹ÅÐÊÒ¾ѹ¸Ø¡ ºÑ àª×éÍ·Õè¡íÒÅѧÃкҴÍÂً


µÒÃÒ§·Õè 2 ¢¹Ò´¡ÒÃ㪌 ¢ ͧÂÒµŒ Ò ¹äÇÃÑ Ê ä¢Œ Ë ÇÑ ´ ãË­‹ ÂÒ Amantadine Rimantadine Oseltamivir

anamivir

¢¹Ò´¡ÒÃ㪌 ã ¹à´ç ¡ 4.4-8.8 Á¡./¡¡./Çѹ ᵋäÁ‹à¡Ô¹ 150 Á¡./Çѹ ¹Ò¹ 5 Çѹ 4.4-8.8 Á¡./¡¡./Çѹ ᵋäÁ‹à¡Ô¹ 150 Á¡./Çѹ ¹Ò¹ 5-7 Çѹ 2 Á¡./¡¡.ÇѹÅÐ 2 ¤ÃÑ§é ¹Ò¹ 5 Çѹ

¾‹¹à¢ŒÒ¨ÁÙ¡ 10 Á¡. ÇѹÅÐ 2 ¤ÃÑ§é ¹Ò¹ 5 Çѹ

¢¹Ò´¡ÒÃ㪌 ã ¹¼ÙŒ ã Ë­‹ 100 Á¡.ÇѹÅÐ 2 ¤ÃÑ§é ¹Ò¹ 5 Çѹ 100 Á¡.ÇѹÅÐ 2 ¤ÃÑ§é ¹Ò¹ 5-7 Çѹ ¿ 75 Á¡..ÇѹÅÐ 2 ¤Ãѧ é ¹Ò¹ 5 Çѹ ÊíÒËÃѺ䢌ËÇÑ´ãË­‹ µÒÁÄ´Ù¡ÒÅáÅÐ䢌ËÇÑ´ãË­‹ ÊÒ¾ѹ¸Ø㏠ËÁ‹ 2009 ¿ 150 Á¡..ÇѹÅÐ 2 ¤Ãѧ é ¹Ò¹ 5 Çѹ ÊíÒËÃѺ䢌ËÇÑ´¹¡ ¾‹¹à¢ŒÒ¨ÁÙ¡ 10 Á¡. ÇѹÅÐ 2 ¤ÃÑ§é ¹Ò¹ 5 Çѹ

¢¹Ò´¡ÒÃ㪌 ã ¹¼ÙŒ »† Ç ÂâÃ¤äµ »ÃѺŴ¢¹Ò´ µÒÁ¤ÇÒÁÊÒÁÒö¢Í§äµ »ÃѺŴ¢¹Ò´ µÒÁ¤ÇÒÁÊÒÁÒö¢Í§äµ ¿

¿

¶ŒÒ Clcr 10-30 ÁÅ./¹Ò·Õ 㪌¢¹Ò´ 75 Á¡.ÇѹÅФÃÑ§é ¶ŒÒ䵺¡¾Ã‹Í§ ᵋ Clcr > 30 ÁÅ./¹Ò·Õ ãˌ»ÃѺµÒÁ ¤ÇÒÁÊÒÁÒöäµ

¾‹¹à¢ŒÒ¨ÁÙ¡ 10 Á¡. ÇѹÅÐ 2 ¤ÃÑ§é ¹Ò¹ 5 Çѹ

5 . ¼ÙŒ·Õè໚¹¼ÙŒ»†Ç¤ÇÒÁàÊÕè§ÊÙ§áŌÇÂѧäÁ‹à¤ÂÃѺÇѤ«Õ¹áÅÐáÊ´§ÍÒ¡Òâͧ¡ÒÃ໚¹ä¢ŒËÇÑ´ãË­‹àÁ×èÍà¡Ô´¡Òà ÃкҴ¢Í§âä¢Ö¹é (¼Ù·Œ àÕè »š¹¼Ù»Œ dž ¤ÇÒÁàÊÕÂè §ÊÙ§ ¤×Í ¼Ù»Œ dž ÂâäËÑÇã¨ÇÒÂàÃ×Íé Ãѧ ¼Ù»Œ dž ÂâÃ¤äµ ¼Ù»Œ dž ÂâäµÑº ¼Ù»Œ dž ÂàºÒËÇÒ¹ ¼Ù»Œ dž  COPD) 6 . ¼ÙŒ»†Ç»ʹºÇÁ·ÕèÂѧäÁ‹à¤Â䴌ÃѺÇѤ«Õ¹ÁÒ¡‹Í¹ ¡ÒÃ㪌ÂÒµŒÒ¹äÇÃÑÊ䢌ËÇÑ´ãË­‹ ¨ÐµŒÍ§ÃÕºãˌÀÒÂã¹ 36-48 ªÑÇè âÁ§ àÁ×Íè àÃÔÁè ÁÕÍÒ¡ÒÃà¾ÃÒСÒÃ㪌ÂÒ¨ÐÅ´ÇѹáÊ´§ ÍÒ¡ÒÃ䴌´ÇŒ  median à¾Õ§ 1-2.5 Çѹ ËÒ¡àÃÔÁè ãˌÂÒªŒÒ仡ç¨ÐäÁ‹à¡Ô´»ÃÐ⪹ ¢¹Ò´¡ÒÃãˌáÊ´§ä´Œ´§Ñ ã¹µÒÃÒ§·Õè 2

º·ÊÃØ»

áÁŒÇ‹Ò䢌ËÇÑ´ãË­‹¨Ð໚¹âä·Õèà¡Ô´¨Ò¡äÇÃÑÊ áÅÐËÒÂàͧ䴌໚¹Ê‹Ç¹ãË­‹ ᵋ¡çÁռٌ»†Çºҧ¡Å؋Á·Õè¨íÒ໚¹µŒÍ§ 䴌ÃѺÂÒµŒÒ¹äÇÃÑÊ «Öè§ä´Œá¡‹ ¼ÙŒ»†ÇÂÁÕ»˜­ËÒàÃ×èͧÀÙÁԤ،Á¡Ñ¹â亡¾Ã‹Í§ ËÃ×Í䴌ÃѺÂÒ·ÕèÁÕÄ·¸Ôì¡´ÀÙÁԤ،Á¡Ñ¹µÒÁ¸ÃÃÁªÒµÔ ËÃ×ͼٷŒ àÕè »š¹¼Ù»Œ dž ¤ÇÒÁàÊÕÂè §ÊÙ§ (ઋ¹ ¼Ù»Œ dž ÂâäËÑÇã¨ÇÒÂàÃ×Íé Ãѧ ¼Ù»Œ dž ÂâÃ¤äµ ¼Ù»Œ dž ÂâäµÑº ¼Ù»Œ dž ÂàºÒËÇÒ¹ ¼Ù»Œ dž  COPD áÅмٌ»†Ç·Õè͌ǹ) à¾ÃÒÐËÒ¡¼ÙŒ»†ÇÂàËʋҹÕéµÔ´àª×éÍ䢌ËÇÑ´ãË­‹ äÁ‹Ç‹Ò¨Ð໚¹ä¢ŒËÇÑ´ãË­‹µÒÁÄ´Ù¡ÒÅ ËÃ×Í䢌ËÇÑ´¹¡ ËÃ×Í ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ¼ÙŒ»†ÇÂàËŋҹÕé¨ÐàÊÕ觵‹Í¡ÒÃà¡Ô´ÀÒÇÐá·Ã¡«ŒÍ¹·ÕèÃعáçáÅÐÍÒ¨ÍѹµÃÒ¶֧ªÕÇԵ䴌 ¨Ö§¨íÒ໚¹µŒÍ§ä´ŒÃºÑ ÂÒà¾×Íè ¡ÒÃÃÑ¡ÉÒ áÅСÒÃàÃÔÁè ÂÒ¡çµÍŒ §àÃÔÁè ãˌàÃçÇ·ÕÊè ´Ø â´ÂµŒÍ§ãˌÂÒÀÒÂã¹ 48 ªÑÇè âÁ§ËÅѧàÃÔÁè áÊ´§ÍÒ¡Òà áÁŒÇҋ àÀÊѪ¡ÃªØÁª¹¨ÐäÁ‹ÁºÕ ·ºÒ·ã¹¡Òè‹ÒÂÂÒ¹Õãé ¹ÃŒÒ¹ÂÒâ´ÂµÃ§ ᵋ¡Ò÷íÒ¤ÇÒÁࢌÒã¨Ç‹Ò¼Ù»Œ dž ÂÃÒÂã´µŒÍ§ãªŒÂÒ áÅÐ µŒÍ§àÃÔÁè 㪌ÂÒàÁ×Íè äèÐÁÕ»ÃÐ⪹ã¹¡Òê‹Ç¼ٻŒ dž ÂÁÒ¡ à¾ÃÒÐàÀÊѪ¡ÃªØÁª¹ÁÕâÍ¡ÒÊ·Õ¨è оº¼Ù»Œ dž ÂàËŋҹÕãé ¹ÃŒÒ¹ÂÒÍÂÙá‹ ÅŒÇ ºÃÃ³Ò¹Ø ¡ ÃÁ 1. Beigel J., Bray M. Current and future antiviral therapy of severe seasonal and avian influenza. Antiviral Research 2008;78: 91-102. 2. Fleming DM. The management of influenza in people of working age. Occup. Med. 2002;52:259-263. 3. Harrod ME., Emery S., Dwyer DE. Antivirals in management of an influenza pandemic. Med. J. Autralia 2006;185:S58-S61. 4. Stiver G. The treatment of influenza with antiviral drugs. Canadian Med. Assoc. J. 2003;168:49-56. 5. Sugrue RJ., Tim BH., Yeo DS., Sutejo R. Antiviral drugs for the control of pandemic influenza virus. Ann. Acad. Med. Singapore 2007;37:518-524. 6. Turner D., Wailoo A., Nicholson K., Cooper N., Sutton A., Abrams K. Systematic review and economic decision modeling for the prevention and treatment of influenza A and B. Health Technology Assessment 2003;7(35):1-6. 7. Ward P., Small I., Smith J., Suter P., Dutkowski R. Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic. J. Antimicrob. Chemother. 2005;55:S1-S21. 51


Ẻ·´Êͺ¤ÇÒÁÃٌ

¶ŒÒ·‹Ò¹µÍº¤íÒ¶ÒÁ¶Ù¡Í‹ҧ¹ŒÍ 7 ¢ŒÍ ·‹Ò¹¨Ðä´ŒÃºÑ CE 2 ˹‹Ç¡Ե

àÅ×Í¡¤íҵͺ·Õè¶Ù¡µŒÍ§·ÕèÊØ´áŌǡҡºÒ·ã¹¡ÃдÒɤíҵͺ ʋ§¡ÅѺÁÒÂѧÊÁÒ¤ÁÏ ÀÒÂã¹Çѹ·Õè 31 ¸Ñ¹ÇÒ¤Á 2552

1. äÇÃÑÊ·Õ衋Íãˌà¡Ô´âä䢌ËÇÑ´ãË­‹¤×Í ¡. DNA virus ¢. Rhinovirus ¤. Influenza A RNA virus §. H. influenzae 2. àª×éÍã´à»š¹µŒ¹à˵آͧ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ? ¡. H1N1 ¢. H5N5 ¤. H5N1 §. H1N5 3. ÂÒ Oseltamivir ໚¹ÂÒµŒÒ¹äÇÃÑÊ·ÕèÍÍ¡Ä·¸Ôìâ´Â ¡. ÂѺÂÑ駡ÒÃà¡ÒТͧäÇÃÑÊ·Õ輹ѧà«Åŏ·Ò§à´Ô¹ËÒÂ㨠¢. ÂѺÂÑ駡ÒÃແ´ ion channel ·Õè M2 protein ¤. ÂѺÂÑ駡Ò÷íÒ§Ò¹¢Í§à͹ä«Á neuraminidase ·íÒãˌäÇÃÑÊ µÒ §. ÂѺÂÑ駡Ò÷íÒ§Ò¹¢Í§à͹ä«Á neuraminidase ·íÒãˌäÇÃÑÊ ËÁ´¤Ø³ÊÁºÑµÔà¡ÒеԴà«Åŏ 4. ÂÒã´à»š¹ÂÒ·Õè¤ÇÃàÅ×͡㪌Íѹ´ÑºááÊíÒËÃѺÃÑ¡ÉÒ䢌ËÇÑ´¹¡? ¡. Amantadine ¢. Rimantadine ¤. Oseltamivir §. Zanamivir

7. à¾ÃÒÐà˵Øã´ àÃÒ¨Ö§äÁ‹¹Òí Oseltamivir ÁÒ㪌»Í‡ §¡Ñ¹ä¢ŒËÇÑ´ãË­‹ ÊÒ¾ѹ¸ØãËÁ‹ 2009 ? ¡. à¾ÃÒСÅÑÇ»˜­ËÒ´×éÍÂÒ ¢. à¾ÃÒÐ㪌»‡Í§¡Ñ¹äÁ‹ä´Œ¼Å ¤. à¾ÃÒÐàÃÒÁÕÇ¤Ñ «Õ¹»‡Í§¡Ñ¹âä¹Õâé ´ÂµÃ§ §. à¾ÃÒÐÂÒÁÕÃÒ¤Òᾧ áÅСÒû‡Í§¡Ñ¹µŒÍ§ãªŒã¹»ÃЪҡà ¨íҹǹÁÒ¡ 8. ¢ŒÍã´¶Ù¡µŒÍ§ÊíÒËÃѺẺἹ¡ÒÃãˌÂÒ Oseltamivir 㹡Òà ÃÑ¡ÉÒ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ 2009 ? ¡. 75 Á¡. ઌÒ-àÂç¹ ¹Ò¹ 5 Çѹ àÃÔÁè ÀÒÂã¹ 48 ªÑÇè âÁ§¢Í§¡Òà áÊ´§ÍÒ¡Òà ¢. 75 Á¡. ઌÒ-àÂç¹ ¹Ò¹ 5 Çѹ àÃÔÁè ÀÒÂã¹ 48 ªÑÇè âÁ§ËÅѧµÃǨ Â×¹Âѹ¡ÒõԴàª×Íé ¤. 150 Á¡. ઌÒ-àÂç¹ ¹Ò¹ 5 Çѹ àÃÔÁè ÀÒÂã¹ 48 ªÑÇè âÁ§¢Í§¡Òà áÊ´§ÍÒ¡Òà §. 150 Á¡. ઌÒ-àÂç¹ ¹Ò¹ 5 Çѹ àÃÔÁè ÀÒÂã¹ 48 ªÑÇè âÁ§ËÅѧ µÃǨÂ×¹Âѹ¡ÒõԴàª×Íé 9. ¢ŒÍã´äÁ‹ãª‹¼ÅäÁ‹¾Ö§»ÃÐʧ¤¢Í§ Oseltamivir? ¡. »Ç´ËÑÇ ¢. µÑºÍÑ¡àʺ ¤. à¡Ô´ÀÒ¾ËÅ͹ §. ¤Å×è¹äʌ ÍÒà¨Õ¹

5. ¢ŒÍã´¶Ù¡µŒÍ§ÊíÒËÃѺ ÂÒ Zanamivir? ¡. µŒÍ§»ÃѺ¢¹Ò´ãˌ㹼ٌ»†ÇÂâÃ¤äµ 10. ¼ÙŒ»†ÇÂÃÒÂã´·ÕèäÁ‹¨íÒ໚¹µŒÍ§ä´ŒÃѺÂÒµŒÒ¹äÇÃÑÊ䢌ËÇÑ´ãË­‹? ¢. 㪌ÃÑ¡ÉÒ䢌ËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ¡. ¼ÙŒÊÙ§ÍÒÂØ·ÕèáÊ´§ÍÒ¡ÒÃ䢌ËÇÑ´ãË­‹ã¹ª‹Ç§·ÕèÁÕ¡ÒÃÃкҴ ¤. 㪌»Í‡ §¡Ñ¹ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸Ø㏠ËÁ‹ 2009 ã¹¼Ù·Œ ÁÕè ¤Õ ÇÒÁàÊÕÂè §ÊÙ§ ¢Í§ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 §. ໚¹ÂÒ¾‹¹¨ÁÙ¡ ¨Ö§ÍÒ¨·íÒãˌà¡Ô´ÀÒÇÐËͺ¢Öé¹ä´Œ ¢. ¼ÙŒ»†ÇÂàºÒËÇÒ¹·ÕèáÊ´§ÍÒ¡ÒÃ䢌ËÇÑ´ãË­‹ã¹ª‹Ç§·ÕèÁÕ¡Òà ÃкҴ¢Í§ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ᵋ¼ÙŒ·Õè䴌ÃѺ 6. ¢ŒÍã´¶Ù¡µŒÍ§ÊíÒËÃѺ ÂÒ Amantadine? ÇѤ«Õ¹ä¢ŒËÇÑ´ãË­‹ÁÒáÅŒÇ ¡. ÊÒÁÒö㪌໚¹ÂÒ»‡Í§¡Ñ¹ä¢ŒËÇÑ´¹¡ ¤. ¼Ù·Œ ÁÕè ÀÕ ÒÇÐ͌ǹá¢ç§áçáÊ´§ÍÒ¡ÒÃ䢌ËÇÑ´ãË­‹ 㹪‹Ç§·ÕÁè Õ ¢. ·íÒãˌà¡Ô´¼ÅäÁ‹¾Ö§»ÃÐʧ¤àÃ×èͧ¹Í¹äÁ‹ËÅѺ ¡ÒÃÃкҴ¢Í§ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ¤. ÂÒ¶Ù¡·íÒÅÒÂâ´ÂµÑºà»š¹ËÅÑ¡ ¨Ö§äÁ‹µŒÍ§»ÃѺ¢¹Ò´ã¹¼ÙŒ»†Ç §. ¼ÙŒ·ÕèáÊ´§ÍÒ¡ÒÃ䢌ËÇÑ´ãË­‹ã¹ª‹Ç§·ÕèÁÕ¡ÒÃÃкҴ¢Í§ âÃ¤äµ ä¢ŒËÇÑ´ãË­‹ÊÒ¾ѹ¸ØãËÁ‹ 2009 ᵋ¡ÒÃáÊ´§ÍÒ¡ÒÃ͋͹ §. äÁ‹¤Í‹ ÂÁÕ»­ ˜ ËÒàÃ×Íè §´×Íé ÂÒ ¨Ö§ãªŒ¡¹Ñ ÁÒ¹Ò¹ ¨¹áÁŒ»¨˜ ¨Øº¹Ñ ¡ç处 ÁÒ¡ ¤×Í ÂѧäÁ‹ÁÕËͺ ÁÕ䢌µèíÒæ ¤§ãªŒÍÂً 52


ẺµÍº¤íÒ¶ÒÁ¨Ò¡º·¤ÇÒÁÇÔªÒ¡Òà »‚·Õè 8 ©ºÑº·Õè 46 à´×͹µØÅÒ¤Á 2552 àÃ×èͧ ÂÒµŒÒ¹äÇÃÑÊÊíÒËÃѺÃÑ¡ÉÒ䢌ËÇÑ´ãË­‹

ª×Íè ¼ÙµŒ ͺ............................................................................................................................................................................................ àÅ¢·Õãè º»ÃСͺâäÈÔÅ»Ð...........................................................àÅ¢ÃËÑÊÊÁÒªÔ¡ÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹Ï............................. ¡Ò¡ºÒ· (x) ŧ㹪‹Í§ÊÕàè ËÅÕÂè Á·Õàè »š¹¤íҵͺ·Õ¶è ¡Ù µŒÍ§ ¡.)

¢.)

¤.)

§.)

¨.)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

53


¡ÃسҹíÒʋ§

ÊÁÒ¤ÁàÀÊѪ¡ÃÃÁªØÁª¹ (»ÃÐà·Èä·Â) àÅ¢·Õè 40 «ÍÂÊØ¢ÁØ ÇÔ· 38 ¶¹¹ÊØ¢ÁØ ÇÔ· á¢Ç§¤ÅͧàµÂ ࢵ¤ÅͧàµÂ ¡Ãا෾ÁËÒ¹¤Ã 10110 54

µÔ´áʵÁ»Š 3 ºÒ· ·Õè¹Õè


55


¢‹ÒÇ»ÃЪÒÊÑÁ¾Ñ¹¸

¤³ÐàÀÊѪÈÒʵÏ ÁËÒÇÔ·ÂÒÅÑ¢͹ᡋ¹ áÅÐÈٹ»ÃÐÊÒ¹§Ò¹¡ÒÃÈÖ¡ÉÒ àÀÊѪÈÒʵÏáˋ§»ÃÐà·Èä·Â (È.È.À.·.) 䴌ÃѺÁͺËÁÒ¨ҡÊÀÒàÀÊѪ¡ÃÃÁ áÅÐÁÙ Å ¹Ô ¸Ô à ÀÊÑ ª ÈÒʵÏ à¾×è Í ÊÑ § ¤Á (ÁÀÊ) ¡í Ò Ë¹´¨Ñ ´ ¡ÒûÃÐªØ Á ÊÁÑ ª ªÒ àÀÊÑ ª ¡ÃÃÁä·Â 96 »‚ “º·ºÒ·àÀÊÑ ª ¡Ã㹡ÒüÅÔ µ ÂÒà¾×è Í ÊÑ § ¤Á” à¾×è Í àµÃÕÂÁ¡ÒÃÊÁѪªÒàÀÊѪ¡ÃÃÁä·Â 100 »‚ (¾.È.2556) ã¹ÇѹÍѧ¤Ò÷Õè 8 ¸Ñ¹ÇÒ¤Á 2552 ³ ˌ Í §»ÃÐªØ Á ªÑé ¹ 10 ÍÒ¤ÒùÇÑ µ ¡ÃÃÁ·Ò§àÀÊÑ ª ÈÒʵÏ ¤³Ð àÀÊÑ ª ÈÒʵÏ ¨Ø Ì Òŧ¡Ã³ Á ËÒÇÔ · ÂÒÅÑ Â

¨Ö§ã¤Ã‹¢ÍàÃÕ¹àªÔ­àÀÊѪ¡Ã·Ø¡·‹Ò¹à¢ŒÒËÇÁ¡ÒûÃЪØÁ´Ñ§¡Å‹ÒÇ â´ÂäÁ‹ à ÊÕ Â ¤‹ Ò ãªŒ ¨‹ Ò Â áÅÐÊÒÁÒö Download ÃÒÂÅÐàÍÕ Â ´ ¡ÒÃ¨Ñ ´ »ÃÐªØ Á 䴌 ·Õè www.pharmacycouncil.org ËÃ× Í

http://pharm.kku.ac.th/ ÊÒÁÒöŧ·ÐàºÕ¹ࢌÒËÇÁ»ÃЪØÁÀÒÂã¹Çѹ·Õè 23 ¾ÄȨԡÒ¹ 2552 ¼‹Ò¹Ãкº Online áÅÐ µÃǨÊͺÃÒª×Íè ¡ÒÃŧ·ÐàºÕ¹䴌·Õè http://pharm.kku.ac.th/ ËÃ×Íŧ·ÐàºÕ¹ ·Ò§â·ÃÊÒà 0 4320 2379 Êͺ¶ÒÁÃÒÂÅÐàÍÕ´ à¾ÔÁè àµÔÁ䴌·Õè ¤Ø³·Í§¤íÒ Ç§É¾ÃШѹ·Ã ËÃ×Í ¤Ø³ÈÔÃ¨Ô ÃÃÂÒ á¡ŒÇÊÒÃÀÙÁÔ ËÁÒÂàÅ¢ 0 4320 2378 µ‹Í 2131 áÅÐ 2132 56

journal46  

journal46Oct2010