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Original Article
∫∑§—¥¬àÕ À◊¥‡ªìπ‚√§‡√◊ÈÕ√—ß·≈–ªí≠À“ “∏“√≥ ÿ¢∑’Ë ”§—≠„πª√–‡∑»‰∑¬·≈–Õ”‡¿Õ∫“ß∫—«∑Õß Àπ÷Ëß„πªí≠À“°“√
¥Ÿ·≈ºŸâªÉ«¬‚√§À◊¥§◊Õ°“√¡’·æ∑¬åÀ≈“¬§π¥Ÿ·≈ºŸâªÉ«¬ À√◊Õ‰¡à‰¥â√—∫°“√¥Ÿ·≈Õ¬à“ß∂Ÿ°µâÕßµ“¡¡“µ√∞“π·≈–‰¡à µàÕ‡π◊ËÕß ‚√ß欓∫“≈∫“ß∫—«∑Õß®÷߉¥â®—¥µ—Èߧ≈‘π‘°‚√§À◊¥¢÷Èπ„π‡¥◊Õπ‡¡…“¬π 2550 ‡æ◊ËÕ®—¥√–∫∫°“√¥Ÿ·≈ºŸâ- ªÉ«¬‚√§À◊¥„À≥⡓µ√∞“π¢Õß GINA ·≈–»÷°…“·∫∫¬âÕπÀ≈—߇™‘ßæ√√≥π“π’ȇª√’¬∫‡∑’¬∫º≈ „π 2 ™à«ß‡«≈“
§◊Õµ—Èß·µà 1 µÿ≈“§¡ æ.». 2549 ∂÷ß 31 ¡’π“§¡ æ.». 2550 ´÷Ë߇ªìπ¢âÕ¡Ÿ≈°àÕπ®—¥µ—Èߧ≈‘π‘°‚√§À◊¥ °—∫µ—Èß·µà 1 µÿ≈“§¡ æ.». 2550 ∂÷ß 31 ¡’π“§¡ æ.». 2551 ´÷Ë߇ªìπ¢âÕ¡Ÿ≈À≈—ß®—¥µ—Èߧ≈‘π‘°‚√§À◊¥ ®”π«π 60 §π ‡æ◊ËÕ ª√–‡¡‘πª√– ‘∑∏‘º≈∑—Ë«‰ª¢Õß°“√√—°…“ºŸâªÉ«¬‚√§À◊¥„π‚√ß欓∫“≈∫“ß∫—«∑Õß
º≈°“√»÷°…“ æ∫«à“¡’ºŸâªÉ«¬ 60 √“¬ ∑’ˇ¢â“√à«¡°“√»÷°…“∑—Èß Õß√–¬– ·æ∑¬åπ”·π«∑“ß°“√√—°…“‚√§
À◊¥¡“„™â°—∫ ºŸâªÉ«¬Õ¬à“߇À¡“– ¡∑ÿ°√“¬ (√âÕ¬≈– 100) ¡’Õ—µ√“ºŸâªÉ«¬‚√§À◊¥æà𬓉¥â∂Ÿ°µâÕß √âÕ¬≈– 51.7 Õ—µ√“°“√‡¢â“√—∫°“√√—°…“∑’ËÀâÕß©ÿ°‡©‘π≈¥≈ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p-value = 0.005) Õ—µ√“ºŸâªÉ«¬‡¢â“
√—∫°“√√—°…“„π‚√ß欓∫“≈≈¥≈ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p-value = 0.001) §à“ ¡√√∂¿“æ¢Õߪե (PEFR)
„π√–¥—∫¥’‡æ‘Ë¡¢÷Èπ®“°√âÕ¬≈– 11.7 ‡ªìπ √âÕ¬≈– 76.6 ·≈–¡’√âÕ¬≈– 51.7 ∑’˪√–‡¡‘π°“√§«∫§ÿ¡‚√§À◊¥¥â«¬
µπ‡Õß«à“Õ¬Ÿà„π√–¥—∫§«∫§ÿ¡‚√§À◊¥‰¥â¥’·≈â« ´÷Ëßæ∫«à“ºŸâªÉ«¬ à«π„À≠à ¡’√–¥—∫§«“¡√ÿπ·√ߢÕß‚√§À◊¥≈¥≈ß
¡’§«“¡ “¡“√∂ªØ‘∫—µ‘°‘®«—µ√ª√–®”«—π·≈–ß“πª√–®”‰¥â¥’¢÷Èπ
√ÿª À≈—߇¢â“√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥ æ∫«à“ °≈ÿࡵ—«Õ¬à“ß¡’º≈°“√√—°…“∑’Ë¥’¢÷Èπ„π∑ÿ°¥â“π‡¡◊ËÕ
‡∑’¬∫°—∫°àÕπ‡¢â“§≈‘π‘° ‚¥¬æ∫«à“Õ“°“√ÀÕ∫‡Àπ◊ËÕ¬„π‡«≈“°≈“ß«—π·≈–°≈“ߧ◊π °“√„™â¬“æàπ¢¬“¬À≈Õ¥≈¡
°“√¡“æàπ¬“∑’ËÀâÕß©ÿ°‡©‘π ·≈–°“√æ—°√—°…“µ—«„π‚√ß欓∫“≈ ≈¥≈ß §à“ ¡√√∂¿“æ¢Õߪե (PEFR) ¡’
·π«‚πâ¡¥’¢÷Èπ ¡’º≈„Àâ°≈ÿࡵ—«Õ¬à“ß¡’§ÿ≥¿“æ™’«‘µ¥’¢÷Èπ · ¥ß∂÷ߪ√– ‘∑∏‘º≈∑’Ë¥’„π°“√æ—≤π“√–∫∫°“√¥Ÿ·≈
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„π‚√ß欓∫“≈∫“ß∫—«∑Õß
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°√–µÿâπ∫“ß™π‘¥¡“°°«à“§πª√°µ‘(1) ´÷ËßÕ“®®–‡ªìπ®“°
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§«—πÀ√◊Õ¡≈æ‘…µà“ß Ê À√◊Õ¿“¬„π¢ÕߺŸâªÉ«¬‡Õß ‡™àπ
§«“¡‡§√’¬¥ °“√æ—°ºàÕπ∑’ˉ¡à‡æ’¬ßæÕ ‡¡◊ËÕ‡°‘¥°“√
°√–µÿâπ®–∑”„À⇡Á¥‡≈◊Õ¥¢“«∫“ß™π‘¥ª≈àÕ¬ “√Õ—°‡ ∫ ÕÕ°¡“ ∑”„Àâ¡’°“√Õ—°‡ ∫¢Õß∑“߇¥‘πÀ“¬„® À≈Õ¥≈¡
®–¬‘Ë߉«µàÕ ‘Ëß°√–µÿâπ ¡’°“√∫«¡¢Õߺπ—ßÀ≈Õ¥≈¡ ·≈–
Journal of Health Science 2008 Vol. 17 Supplement V
SV1412
°≈â“¡‡π◊ÈÕÀ≈Õ¥≈¡À¥‡°√Áß∑”„ÀâÀ≈Õ¥≈¡µ’∫·≈–‡ªì𠓇Àµÿ¢ÕßÕ“°“√µà“ß Ê „πºŸâªÉ«¬‚√§À◊¥ √â“ߧ«“¡
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ª√–‡∑»∑—Ë«‚≈° √«¡∑—Èߪ√–‡∑»‰∑¬ ªí≠À“¥—ß°≈à“«
∑”„À⇰‘¥º≈‡ ’¬µàÕ§ÿ≥¿“æ™’«‘µ¢ÕߺŸâªÉ«¬‚¥¬∑”„Àâ ÿ¢¿“æ√à“ß°“¬¥âÕ¬≈ß®“°°“√∑’˺ŸâªÉ«¬ÀÕ∫‡Àπ◊ËÕ¬ ·πàπ Àπâ“Õ° ÕàÕπ‡æ≈’¬ ∑”„Àâ ‰¡à “¡“√∂∑”°‘®«—µ√ª√–®”«—π À√◊ÕÕÕ°°”≈—ß°“¬‰¥âµ“¡ª√°µ‘Õ’°∑—È߬—ß àߺ≈µàÕ¿“«–
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·π«∑“ß°“√√—°…“‚√§À◊¥ ´÷Ëß°”À𥂥¬Õߧ尓√
Õπ“¡—¬‚≈° (WHO) √à«¡°—∫ Heart Lung & Blood In- stitute (NHLBI) °”À𥇪ìπ Global Initiative for Asthma (GINA)(4) ¡“„™â ‚¥¬ ¡“§¡Õÿ√‡«™™å√à«¡°—∫
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‰¥âπ”·π«∑“ߢÕß GINA ¡“°”À𥇪ìπ·π«∑“ß°“√
√—°…“‚√§À◊¥„πª√–‡∑»‰∑¬ µ—Èß·µàªï 2537(5) ·≈–
ª√—∫ª√ÿ߇¡◊ËÕ æ.». 2540(6) ·≈– æ.». 2541(7) ‚¥¬
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‡æ◊ËÕ‰ª¢—¥¢«“ß arachidonic acid metabolism ∑”„Àâ
‰¡à “¡“√∂ √â“ß prostaglandin πÕ°π’Ȭ—ß≈¥ microvas- cular leakage ≈¥°“√ √â“ß cytokine ∑”„Àâ≈¥°“√Õ—°‡ ∫
¢ÕßÀ≈Õ¥≈¡ ·≈–∑”„Àâ beta receptor „πÀ≈Õ¥≈¡
∑”ß“π¥’¢÷Èπ ‚¥¬„™â√à«¡°—∫¬“¢¬“¬À≈Õ¥≈¡™π‘¥æàπ
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·≈–√âÕ¬≈– 21 µâÕ߇¢â“√—∫°“√√—°…“„πÀâÕß©ÿ°‡©‘π(9) æ∫
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æà𠇵’¬√Õ¬¥å ¡’°“√»÷°…“¢Õß Suissa ·≈–§≥– æ∫
«à“°“√„™â¬“æà𠇵’¬√Õ¬¥åÕ¬à“ß ¡Ë”‡ ¡Õ®– “¡“√∂
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‡¡…“¬π æ.». 2550 ‚¥¬¡’§≥–∑”ß“πª√–°Õ∫¥â«¬
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™à«ß‡«≈“ µ—Èß·µà 1 µÿ≈“§¡ æ.». 2549 ∂÷ß 31 ¡’π“§¡
æ.». 2550 ´÷Ë߇ªìπ¢âÕ¡Ÿ≈°àÕπ®—¥µ—Èߧ≈‘π‘°‚√§À◊¥ ·≈–
µ—Èß·µà 1 µÿ≈“§¡ æ.». 2550 ∂÷ß 31 ¡’π“§¡ æ.». 2551
´÷Ë߇ªìπ¢âÕ¡Ÿ≈À≈—ß®—¥µ—Èߧ≈‘π‘°‚√§À◊¥ ®”π«π 60 §π
∑”°“√√«∫√«¡¢âÕ¡Ÿ≈·≈â««‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬‚ª√·°√¡
”‡√Á®√Ÿª ∂‘µ‘„π°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ §◊Õ §à“Õ—µ√“ à«π
√âÕ¬≈– (percentage) §à“‡©≈’ˬ (mean) ·≈– à«π‡∫’ˬß-
‡∫π¡“µ√∞“π (SD) ·≈–°“√‡ª√’¬∫‡∑’¬∫µ—«™’È«—¥°“√
§«∫§ÿ¡‚√§À◊¥°àÕπ-À≈—ß °“√‡ªî¥§≈‘π‘°‚√§À◊¥ ‚¥¬„™â ∂‘µ‘‡™‘ßÕπÿ¡“π paired t-test °“√‡ª√’¬∫‡∑’¬∫§à“ peak expiratory flow rate °àÕπ-À≈—ß°“√‡ªî¥§≈‘π‘°‚√§À◊¥
„™â ∂‘µ‘ Pearson chi-square ‚¥¬¡’§«“¡·µ°µà“ß°—π
∑“ß ∂‘µ‘‡ªìπ p-value, 95% CI
‚¥¬¢âÕ¡Ÿ≈∑’Ëπ”¡“»÷°…“‰¥â·°à
1. ‡æ» Õ“¬ÿ °“√»÷°…“ Õ“™’æ ¿Ÿ¡‘≈”‡π“ √–¬–
‡«≈“∑’ˇªìπ‚√§ ª√–«—µ‘°“√ Ÿ∫∫ÿÀ√’Ë °“√¡’‚√§Õ◊Ëπ √à«¡
2. √–¥—∫§«“¡√ÿπ·√ߢÕß‚√§°àÕπ·≈–À≈—ß
‡¢â“√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥
3. º≈°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬°àÕπ·≈–À≈—߇¢â“√—∫
°“√√—°…“„π§≈‘π‘°‚√§À◊¥
4. °“√µ‘¥µ“¡°“√√—°…“ºŸâªÉ«¬‚√§À◊¥µ“¡
·π«∑“ß°“√√—°…“‚√§À◊¥
5. º≈°“√µ√«® ¡√√∂¿“æªÕ¥°àÕπ·≈–À≈—ß
‡¢â“√—∫°“√√—°…“
6. §–·ππ°“√ª√–‡¡‘𧫓¡ “¡“√∂„π°“√
§«∫§ÿ¡‚√§À◊¥¢Õßµπ‡Õß
º≈°“√»÷°…“
°≈ÿࡵ—«Õ¬à“ß®”π«π 60 √“¬ à«π„À≠à‡ªìπ‡æ»À≠‘ß
®”π«π 46 √“¬ (76.7%) Õ“¬ÿ‡©≈’ˬ 48.50 ªï (Õ“¬ÿ 18
-75 ªï) ‡ªìπ‚√§À◊¥¡“‡©≈’ˬ 24.5 ªï (√–À«à“ß 2-61 ªï) à«π„À≠à√–¥—∫°“√»÷°…“µË”°«à“À√◊Õ‡∑à“°—∫ª√–∂¡»÷°…“
53 √“¬ (88.3%) Õ“™’æ√—∫®â“ß 31 √“¬ (51.7%) ¿Ÿ¡‘
≈”‡π“Õ¬ŸàπÕ°‡¢µ√—∫º‘¥™Õ∫„π‚√ß欓∫“≈ 54 √“¬
(90.0%) ¡’ª√–«—µ‘ Ÿ∫∫ÿÀ√’Ë 11 √“¬ (18.3%) ·≈–‡ªìπ
‚√§À◊¥√à«¡°—∫‚√§Õ◊Ëπ 18 √“¬ (30.0%)
°“√ª√–‡¡‘𧫓¡√ÿπ·√ß‚√§°àÕπ·≈–À≈—߇¢â“√—∫°“√
√—°…“„π§≈‘π‘°‚√§À◊¥
°àÕπ‡¢â“√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥ºŸâªÉ«¬ à«π
„À≠à√âÕ¬≈– 70 ¡’§«“¡√ÿπ·√ߢÕß‚√§„π√–¥—∫ª“π°≈“ß
√Õß≈ß¡“√âÕ¬≈– 16.7 ¡’§«“¡√ÿπ·√ߢÕß‚√§„π√–¥—∫¡“°
¡’‡æ’¬ß√âÕ¬≈– 3.3 ∑’Ë¡’Õ“°“√„π√–¥—∫∑’˧«∫§ÿ¡‰¥â º≈°“√µ‘¥µ“¡ºŸâªÉ«¬‚√§À◊¥∑’Ë√—∫°“√√—°…“µàÕ‡π◊ËÕß æ∫«à“ºŸâªÉ«¬‚√§À◊¥ à«π„À≠à¡’√–¥—∫§«“¡√ÿπ·√ߢÕß
‚√§≈¥≈ß ‚¥¬¡’‡æ’¬ß 1 √“¬§‘¥‡ªìπ√âÕ¬≈– 1.7 ∑’ˬ—ß¡’
§«“¡√ÿπ·√ߢÕß‚√§„π√–¥—∫¡“° ·≈–‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫
√–¥—∫§«“¡√ÿπ·√ߢÕß‚√§°àÕπ·≈–À≈—߇¢â“§≈‘π‘°‚√§
À◊¥‚¥¬‚¥¬ paired-samples t-test æ∫«à“¡’§«“¡·µ°
µà“ß°—π∑“ß ∂‘µ‘ (p-value< 0.001) (µ“√“ß∑’Ë 1)
‡ª√’¬∫‡∑’¬∫°“√√—°…“¢ÕߺŸâªÉ«¬°àÕπ·≈–À≈—ß°“√‡¢â“
√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥
º≈°“√»÷°…“æ∫«à“¿“¬À≈—ß∑’˺ŸâªÉ«¬‡¢â“√—∫°“√
µ“√“ß∑’Ë 1 √–¥—∫§«“¡√ÿπ·√ߢÕß‚√§°àÕπ·≈–À≈—߇¢â“√—∫°“√
√—°…“„π§≈‘π‘°‚√§À◊¥
√–¥—∫§«“¡√ÿπ·√ß °àÕπ‡¢â“§≈‘π‘° À≈—߇¢â“§≈‘π‘°
¢Õß‚√§ §π (√âÕ¬≈–) §π (√âÕ¬≈–)
Intermittent 2 (3.3) 11 (18.3)
Mild persistent 6 (10.0) 28 (46.7)
Moderate persistent 42 (70.0) 20 (33.3) Severe persistent 10 (16.7) 1 (1.7)
Total 60 (100) 60 (100)
Journal of Health Science 2008 Vol. 17 Supplement V
SV1414
√—°…“„π§≈‘π‘°‚√§À◊¥¡’§–·ππ‡©≈’ˬ®”π«π§√—ÈߢÕß°“√
πÕπ‚√§æ¬“∫“≈ °“√¡“æàπ¬“∑’ËÀâÕß©ÿ°‡©‘π °“√‡°‘¥
Õ“°“√À◊¥„π‡«≈“°≈“ߧ◊π·≈–°“√„™â short acting beta 2 agonist inhaler ≈¥πâÕ¬°«à“°àÕπ‡¢â“ asthma clinic Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p-value < 0.05) ¥—ß√“¬
≈–‡Õ’¬¥„πµ“√“ß∑’Ë 2
º≈°“√µ‘¥µ“¡°“√√—°…“ºŸâªÉ«¬‚√§À◊¥ „π¥â“π°“√¥Ÿ·≈
Õ¬à“ß∂Ÿ°µâÕßµ“¡¡“µ√∞“π°“√√—°…“‚√§À◊¥
1. Õ—µ√“°“√π”·π«∑“ß°“√¥Ÿ·≈ºŸâªÉ«¬¡“„™âÕ¬à“ß
‡À¡“– ¡¢Õß·æ∑¬å ®“°°“√»÷°…“æ∫«à“ ·æ∑¬å„Àâ°“√
¥Ÿ·≈ºŸâªÉ«¬µ“¡·π«∑“ß°“√√—°…“ºŸâªÉ«¬‚√§À◊¥ µ“¡
·π«∑“ß°“√¥Ÿ·≈ºŸâªÉ«¬‚√§À◊¥¢Õß ¡“§¡Õÿ√‡«™™å √âÕ¬≈–
100
2. Õ—µ√“ºŸâªÉ«¬∑’ˉ¥â√—∫§”·π–π”®“°‡¿ —™°√„π
°“√„™â¬“æàπ‡ªìπ√âÕ¬≈– 100 ‚¥¬¡’°“√ Õπ·≈–
ª√–‡¡‘πº≈∑ÿ°§√—Èß∑’˺ŸâªÉ«¬¡“√—∫∫√‘°“√∑’˧≈‘π‘°‚√§À◊¥
·≈–‡¡◊ËÕ·æ∑¬å —Ëß„™â¬“æàπ (‚¥¬¡’°“√∫—π∑÷° µ‘¥µ“¡º≈
‡ªìπ√“¬∫ÿ§§≈)
3. Õ—µ√“ºŸâªÉ«¬∑’Ë„™â¬“æàπ‰¥â∂Ÿ°µâÕß √âÕ¬≈– 51.7 (31 §π)
4. Õ— µ √ “ ºŸâ ªÉ « ¬ ∑’Ë ‡ °‘ ¥ ¿ “ « – · ∑ √ ° ´â Õ π ® “ ° ¬ “ ‡µ’¬√Õ¬¥å™π‘¥æàπ√âÕ¬≈– 3.3 (2 §π) ‚¥¬¡’‡™◊ÈÕ√“„π
™àÕߪ“° 1 §π ·≈–¡’‡ ’¬ß·À∫ 1 §π
5. Õ—µ√“ºŸâªÉ«¬∑’ˉ¡à¬Õ¡„™â¬“ ‡µ’¬√Õ¬¥å™π‘¥æàπ
√âÕ¬≈– 5 (3 §π) (µ“√“ß∑’Ë 3)
§à“‡©≈’ˬº≈°“√µ√«® ¡√√∂¿“æªÕ¥°àÕπ·≈–À≈—߇¢â“
µ“√“ß∑’Ë 2 ‡ª√’¬∫‡∑’¬∫º≈°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬°àÕπ·≈–À≈—ß°“√‡¢â“√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥ (n = 60)
°àÕπ‡¢â“√—∫°“√√—°…“ ¿“¬À≈—߇¢â“√—∫√—°…“
„π§≈‘π‘°‚√§À◊¥ „π§≈‘π‘°‚√§À◊¥
µ—«™’È«—¥ Mean Std. Mean Std. p-value
Deviation Deviation
1. °“√πÕπ√—°…“„π‚√ß欓∫“≈ (§√—Èß) 0.47 1.096 0.17 0.526 0.001
2. °“√¡“æàπ¬“∑’ËÀâÕß©ÿ°‡©‘π (§√—Èß) 5.10 14.129 1.72 5.279 0.005
3. °“√‡°‘¥Õ“°“√À◊¥„π‡«≈“°≈“ߧ◊π (§√—Èß) 1.42 2.08 0.72 1.31 0.02
4. °“√„™â Short acting beta 2 agonist inhaler 2.45 1.78 1.02 1.12 0.007
5. §à“ PEER (√âÕ¬≈–) 67.48 13.18 85.51 9.72 0.000
µ“√“ß∑’Ë 3 º≈°“√µ‘¥µ“¡°“√√—°…“ºŸâªÉ«¬‚√§À◊¥„π¥â“π°“√‰¥â√—∫°“√¥Ÿ·≈Õ¬à“ß∂Ÿ°µâÕßµ“¡¡“µ√∞“π°“√√—°…“‚√§À◊¥ (n=60 §π)
µ—«™’È«—¥ ®”π«π √âÕ¬≈–
Õ—µ√“°“√π”·π«∑“ß°“√¥Ÿ·≈ºŸâªÉ«¬¡“„™âÕ¬à“߇À¡“– ¡ 60 100
Õ—µ√“ºŸâªÉ«¬‚√§À◊¥∑’ˉ¥â√—∫§”·π–π”®“°‡¿ —™°√„π°“√„™â¬“æàπ 60 100
Õ—µ√“ºŸâªÉ«¬∑’Ë„™â¬“æàπ‰¥â∂Ÿ°µâÕß 31 51.7
Õ—µ√“ºŸâªÉ«¬‡°‘¥Õ“°“√·∑√°´âÕπ®“°°“√„™â¬“æà𠇵’¬√Õ¬¥å 2 3.3
Õ—µ√“ºŸâªÉ«¬∑’ˉ¡à¬Õ¡„™â¬“ ‡µ√’¬√Õ¬¥å™π‘¥æàπ 3 5.0
√—∫°“√√—°…“
º≈°“√µ√«® ¡√√∂¿“æªÕ¥ (PEFR) ¢ÕߺŸâªÉ«¬
‚√§À◊¥°àÕπ‡¢â“§≈‘π‘°‚√§À◊¥ à«π¡“°¡’§à“ ¡√√∂¿“æ ªÕ¥Õ¬Ÿà „π√–¥—∫ª“π°≈“ß√âÕ¬≈– 68.3 ·≈–¡’§à“
¡√√∂¿“æªÕ¥„π√–¥—∫‰¡à¥’√âÕ¬≈– 20 ‡¡◊ËÕ‡¢â“√—∫°“√
√—°…“„π§≈‘π‘°‚√§À◊¥æ∫«à“ ¡√√∂¿“æªÕ¥¢Õß°≈ÿà¡
µ—«Õ¬à“ß à«π¡“°∂÷ß√âÕ¬≈– 76.6 ¡’§à“ ¡√√∂¿“æªÕ¥
Õ¬Ÿà„π√–¥—∫¥’ (µ“√“ß∑’Ë 4)
®“°º≈°“√»÷°…“ æ∫«à“¿“¬À≈—߇¢â“√—∫°“√√—°…“
„π§≈‘π‘°‚√§À◊¥°≈ÿࡵ—«Õ¬à“ß¡’°“√‡æ‘Ë¡¢÷Èπ¢Õß§à“‡©≈’ˬ
¡√√∂¿“æªÕ¥¥’¢÷Èπ §◊Õ¡’°“√‡æ‘Ë¡¢÷Èπ¢Õß PEFR Õ¬à“ß
¡’π—¬ ”§—≠∑“ß ∂‘µ‘
‡¡◊ËÕπ”º≈°“√µ√«® ¡√√∂¿“æªÕ¥ (PEFR) ¢Õß
°≈ÿࡵ—«Õ¬à“ß∑’ˉ¥â¡“°°«à“√âÕ¬≈– 80 °àÕπ·≈–À≈—߇¢â“
√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥¡“‡ª√’¬∫‡∑’¬∫°—π∑“ß ∂‘µ‘
‚¥¬ Pearson chi-square ¡’§«“¡·µ°µà“ß°—πÕ¬à“ß¡’
π—¬ ”§—≠∑“ß ∂‘µ‘ (p-value < 0.001)
µ“√“ß∑’Ë 5 §–·ππ°“√ ª√–‡¡‘𧫓¡ “¡“√∂„π°“√§«∫§ÿ¡‚√§À◊¥¢Õßµπ‡Õß (µ“¡·∫∫ª√–‡¡‘π°“√§«∫§ÿ¡‚√§À◊¥ ACT) (n=60)
√–¥—∫§–·ππ ®”π«π √âÕ¬≈–
πâÕ¬°«à“ 20 §–·ππ (¬—ߧ«∫§ÿ¡‚√§À◊¥‰¥â‰¡à¥’π—°) 29 48.3
§–·ππ 20-24 §–·ππ (Õ“®®–§«∫§ÿ¡‚√§À◊¥‰¥â¥’·≈â«) 31 51.7
§–·ππ 25 §–·ππ ( “¡“√∂§«∫§ÿ¡‚√§À◊¥‰¥âÕ¬à“ß ¡∫Ÿ√≥å) - -
°“√ª√–‡¡‘𧫓¡ “¡“√∂„π°“√§«∫§ÿ¡‚√§À◊¥¢Õß µπ‡Õß
º≈°“√ª√–‡¡‘π°“√§«∫§ÿ¡‚√§À◊¥‚¥¬„™â·∫∫
ª√–‡¡‘π°“√§«∫§ÿ¡‚√§À◊¥ ª√–‡¡‘𧫓¡ “¡“√∂„π
°“√§«∫§ÿ¡‚√§À◊¥¢Õßµπ‡Õß „π‡¥◊Õπ ÿ¥∑⓬∑’Ë¡“√—∫
°“√µ√«®√—°…“„π§≈‘π‘°‚√§À◊¥ æ∫«à“ºŸâªÉ«¬„À⧖·ππ
°“√§«∫§ÿ¡‚√§À◊¥¢Õßµπ‡Õß„π√–¥—∫∑’Ë∫àß™’È«à“ºŸâªÉ«¬
“¡“√∂§«∫§ÿ¡‚√§À◊¥‰¥â¥’·≈â«√âÕ¬≈– 51.7 à«πÕ’°
√âÕ¬≈– 48.3 „À⧖·ππ∑’Ë∫àß™’È«à“ºŸâªÉ«¬¬—ߧ«∫§ÿ¡‚√§
À◊¥‰¥â ‰¡à¥’π—° ‚¥¬‰¡à¡’ºŸâªÉ«¬§π„¥„À⧖·ππ°“√§«∫§ÿ¡
‚√§À◊¥¢Õßµπ‡Õß«à“ “¡“√∂§«∫§ÿ¡‚√§‰¥âÕ¬à“ß ¡∫Ÿ√≥å (µ“√“ß∑’Ë 5)
«‘®“√≥å
°“√»÷°…“§√—Èßπ’È¡’ºŸâªÉ«¬∑’Ë∂Ÿ°§—¥‡≈◊Õ°‡¢â“¡“»÷°…“
„π°“√»÷°…“ 60 √“¬ à«π„À≠à‡ªìπ‡æ»À≠‘ßÕ¬Ÿà„π«—¬
∑”ß“πÕ“¬ÿ‡©≈’ˬ 48.50 ªï´÷Ë߇ªìπ«—¬∑”ß“π·≈–®“°
¢âÕ¡Ÿ≈°“√»÷°…“æ∫«à“√–¥—∫§«“¡√ÿπ·√ߢÕß‚√§À≈—ß
µ“√“ß∑’Ë 4 º≈°“√µ√«® ¡√√∂¿“æªÕ¥ (PEFR) ¢Õß°≈ÿࡵ—«Õ¬à“ß·¬°µ“¡√–¥—∫µ“¡√ÿπ·√ߢÕß‚√§À◊¥ ®”·π°µ“¡«—π·√°∑’Ë°≈ÿà¡
µ—«Õ¬à“߇¢â“√—∫°“√√—°…“„π§≈‘π‘° ·≈–À≈—߇¢â“§≈‘π‘°‚√§À◊¥ (n=60 §π)
§«“¡√ÿπ·√ߢÕߢÕß‚√§®“°“√ª√–‡¡‘π °àÕπ‡¢â“§≈‘π‘° À≈—߇¢â“§≈‘π‘°
¡√√∂¿“æ∑“ߪե (PEFR) §π (√âÕ¬≈–) §π (√âÕ¬≈–)
‰¡à¥’ (<60%) 12 20.0 1 1.7
ª“π°≈“ß (60-80%) 41 68.3 13 21.7
¥’ (> 81%) 7 11.7 46 76.6
Journal of Health Science 2008 Vol. 17 Supplement V
SV1416
‡¢â“√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥≈¥≈ßÕ¬à“ß¡’π—¬ ”§—≠
∑“ß ∂‘µ‘ °“√‡¢â“√—∫°“√√—°…“„π§≈‘π‘°‚√§À◊¥‚¥¬¬÷¥∂◊Õ À≈—°°“√µ“¡·π«∑“ß°“√√—°…“¢Õß ¡“§¡Õÿ√‡«™™å·Ààß ª√–‡∑»‰∑¬·≈– GINA guideline(4-8) ·æ∑¬åºŸâ∑”°“√
√—°…“„Àâ°“√√—°…“µ“¡·π«∑“ß°“√√—°…“‚¥¬ºŸâªÉ«¬‰¥â
√—∫°“√ª√–‡¡‘π·≈–°“√ª√—∫√–¥—∫§«“¡√ÿπ·√ߢÕß‚√§
·≈–°“√„™â¬“ Ÿ¥ ‡µ’¬√Õ¬¥å‡æ◊ËÕ§«∫§ÿ¡‚√§√âÕ¬≈– 100
´÷Ë߬“ Ÿ¥ ‡µ’¬√Õ¬¥å®–™à«¬≈¥°“√Õ—°‡ ∫¢ÕßÀ≈Õ¥≈¡
º≈µ“¡¡“§◊ÕºŸâªÉ«¬¡’Õ“°“√ÀÕ∫≈¥≈ß¡’ ¡√√∂¿“æ ªÕ¥¥’¢÷Èπ “¡“√∂∑”°‘®«—µ√ª√–®”«—π‰¥âµ“¡ª√°µ‘‡æ‘Ë¡
°“√§«∫§ÿ¡Õ“°“√ÀÕ∫„π¥â“𧫓¡√ÿπ·√ߢÕß‚√§ ºŸâ- ªÉ«¬ à«π„À≠àÕ¬Ÿà„π°≈ÿà¡¡’Õ“°“√√ÿπ·√ߪ“π°≈“ß∂÷ß
√ÿπ·√ßπâÕ¬∂÷ß√âÕ¬≈– 80.0 Õ“®‡π◊ËÕß®“°„π‡¢µÕ”‡¿Õ
∫“ß∫—«∑Õ߇ªìπ™ÿπ™π‡¡◊Õß¡’§«“¡·ÕÕ—¥¢Õß∑’ËÕ¬ŸàÕ“»—¬
·≈–¡’¡≈æ‘…®“°°“√®√“®√ √«¡∑—Èß¡’‚√ßß“π§àÕπ¢â“ß¡“°
´÷Ëß°àÕ„À⇰‘¥¡≈æ‘…„πÕ“°“»´÷Ë߇ªìπµ—«°√–µÿâπ ∑”„Àâ
‡°‘¥‚√§À◊¥¡’§«“¡√ÿπ·√ß¡“°¢÷Èπ(1)
º≈∑’ˉ¥â®“°Õ—µ√“°“√‡¢â“√—∫°“√√—°…“„π‚√ß欓∫“≈
≈¥≈ß·≈–Õ—µ√“°“√¡“√—°…“∑’ËÀâÕß©ÿ°‡©‘π≈¥≈ß ∑”„Àâ
§à“„™â®à“¬∑’Ë ‚√ß欓∫“≈µâÕß„™â „π°“√√—°…“欓∫“≈
ºŸâªÉ«¬°≈ÿà¡π’È≈¥≈ß §à“„™â®à“¬„π°“√√—°…“ºŸâªÉ«¬„π‚√ß- 欓∫“≈À√◊Õ∑’ËÀâÕß©ÿ°‡©‘π„π·µà≈–§√—Èß ‡§¬¡’°“√»÷°…“
«à“(11-13) §à“„™â®à“¬ 2 à«π à«π·√°§◊Õ §à“¬“ §à“ÕÕ°´‘‡®π
§à“„™â®à“¬ à«π‚√ß欓∫“≈ §à“·æ∑¬å §à“欓∫“≈ §à“
‡§√◊ËÕß¡◊Õ„π°“√√—°…“ à«π∑’Ë 2 ‰¥â·°à§à“‡ ’¬‡«≈“∑—Èß
¢ÕߺŸâªÉ«¬·≈–≠“µ‘∑’˵âÕß°“√¥Ÿ·≈ºŸâªÉ«¬ §à“√∂§à“‡¥‘π∑“ß
§à“„™â Õ¬‡∫Á¥‡µ≈Á¥ ®–‡ÀÁπ‰¥â«à“°“√√—°…“„π Asthma Clinic µàÕº≈≈—æ∏å°“√√—°…“ πà“®–¡’§«“¡§ÿ⡵àÕ°“√
¥”‡π‘π°“√Õ¬à“ßµàÕ‡π◊ËÕ߇ªìπÕ¬à“߬‘Ëß Õ¥§≈âÕß°—∫°“√
»÷°…“¢ÕßÕ“√’¬å ¥«ß¥’(13) ·≈–™“≠™—¬ ®—π∑√å«√™—¬°ÿ≈(14)
°“√¥”‡π‘π°“√®—¥µ—Èß Asthma Clinic ‡ªìπ°“√®—¥
√–∫∫∫√‘À“√∑’Ë¥’ ·æ∑¬å„™â‡«≈“πâÕ¬≈ß„π°“√¥Ÿ·≈ºŸâªÉ«¬
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Journal of Health Science 2008 Vol. 17 Supplement V
SV1418
Abstract Outcomes of Treatment in Asthma Clinic at Bang Bua Thong Hospital Praputh Leelaprute
Bang Bua Thong Hospital
Journal of Health Science 2008; 17:SV1411-8.
Asthma is one of the most important chronic health care problems in Thailand and also in Bang Bua Thong District, which drawing attentions, and health resources in providing care for individual.
It was found that most of asthmatic patients did not get continuing and standard treatment. In order to cope with these problems, Bang Bua Thong Hospital had launched a special care in a Asthma Clinic, established according to the guidelines for asthma control, since April 20, 2007. This retro- spective descriptive study was to evaluate the effectiveness of treatment in the Asthma Clinic by reviewing medical records of asthmatic patients. The outcomes between 1 October 2006 - 31 March 2007 and 1 October 2007 - 31 March 2008 of the services of the same group of patients were compared. The effectiveness was defined by the Global Initiative for Asthma (GINA) guidelines 2006.
Among the 60 asthmatic patients included in this study, more appropriate asthma management guidelines were applied in 100 percent of them while 51 percent could use the inhalers correctly.
The emergency attendance rate was reduce with statisitical significance (p-value = 0.055). The hospital admission rate was reduced with statisitical significance (p-value = 0.001). Their lung capacities as measured in terms of Peak Expiratory Flow Rate (PEFR) at good level improved from 11.7 percent to 76.6. Moreover, 51.7 percent proclaimed, in self assessment, that their disorders were under control. All patients who attended this clinic could reduce the severity of an asthmatic attack, and led their normal lives.
This study revealed favorable outcomes of asthma management and treatment in Asthma Clinic, in Bang Bua Thong Hospital, which could improve the quality of life of asthmatic patients.
Key words: Asthma Clinic, treatment, Peak Expiratory Flow Rate
