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Abstract A Pattern for Competency Promotion of Self-care Management in Diabetics with Hypertension

Boonchai Tangsangasaksri*

*Krathumban Hospital, Samutsakorn Province

Diabetes and hypertension increase the chance of a person developing heart disease or stroke, which is called metabolic syndrome. We found that many diabetes patients

(2)

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attending the out-patient department in Krathumban Hospital could not control their blood sugar levels. This quasi-experimental design was aimed at comparing fasting blood sugar levels and blood pressure levels between pre and post utilization of service for competency promotion of self-care intervention at 3-month, 6-month and 9-month inter- vals. The 288 samples were selected by purposive sampling. The research instruments comprised research questionnaire, digital weight and hight scale, sphygmomanometer, and the service pattern for competency promotion for self-care intervention. The prob- lems of the patients and the health-care team were assessed iointly. They were advised about diet control and exercise practiced for 30 minutes. The service pattern for compe- tency promotion to self-care intervention was utilized every 3 months. All samples un- derwent blood tests and blood pressure testing pre and post utilization of service for competency promotion of self-care intervention at 3-month, 6-month and 9-month inter- vals. The results showed that there were significant differences among the fasting blood sugar levels and systolic blood pressure levels pre and post service (F = 7.18, P = 0.00) and (F= 6.95, P = 0.00) by using repeated measure analysis of variance. Service pattern for competency promotion for self-care intervention should be included in the care of diabetes and hypertension disease in hospitals.

Key words: Service pattern, competency promotion, self-care, diabetes, hypertension

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ºŸâªÉ«¬‚√§‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß¢Õ߇®â“Àπâ“∑’Ë  “∏“√≥ ÿ¢¢Õß ∂“π’Õπ“¡—¬„πÕ”‡¿Õ°√–∑ÿà¡·∫π æ∫ªí≠À“

∑’Ë∑”„À⺟âªÉ«¬‚√§‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß„π‡¢µÕ”‡¿Õ

°√–∑ÿà¡·∫π‡°‘¥¿“«–·∑√°´âÕπ‰¥â·°à ªí≠À“ºŸâªÉ«¬¢“¥§«“¡

√Ÿâ‡°’ˬ«°—∫‚√§‡∫“À«“π·≈–‚√§§«“¡¥—π‚≈À‘µ Ÿß, ºŸâªÉ«¬¢“¥

§«“¡µ√–Àπ—°„π°“√ªØ‘∫—µ‘µ—«‡¡◊ËÕæ∫¡’πÈ”µ“≈„π‡≈◊Õ¥ Ÿß

·≈–·√ߥ—π‡≈◊Õ¥ Ÿß, ·≈–ªí≠À“ºŸâªÉ«¬¢“¥§«“¡√Ÿâ‡°’ˬ«°—∫°“√

§«∫§ÿ¡Õ“À“√, °“√ÕÕ°°”≈—ß°“¬ ·≈–°“√¥Ÿ·≈µπ‡Õ߇æ◊ËÕ ªÑÕß°—π¿“«–·∑√°´âÕπ.

‡π◊ËÕß®“°‚√§‡∫“À«“π·≈–‚√§§«“¡¥—π‚≈À‘µ Ÿß‡ªìπ‚√§

‡√◊ÈÕ√—ß∑’˺ŸâªÉ«¬ “¡“√∂¡’™’«‘µÕ¬Ÿà‰¥âÕ¬à“ߪ√°µ‘ ÿ¢∂â“ “¡“√∂

§«∫§ÿ¡‚√§‰¥â‚¥¬°“√¥Ÿ·≈µπ‡Õß∑’Ë¥’. °“√æ—≤π“»—°¬¿“æ

°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬‡À≈à“π’È®–¡’º≈‚¥¬µ√ßµàÕ°“√

§«∫§ÿ¡‚√§. √Ÿª·∫∫°“√®—¥∫√‘°“√¥â«¬°“√„Àâ§«“¡√Ÿâ ºŸâªÉ«¬

‰¥â√—∫√Ÿâ¿“«– ÿ¢¿“æ¢Õßµπ‡Õß∑’Ë®–µâÕß¡’ à«π√à«¡„π°“√

ª√–‡¡‘π¿“«– ÿ¢¿“æ¢Õßµπ‡Õß, „Àâ§”·π–π”„π°“√ªØ‘∫—µ‘µ—«

∑’Ë∂Ÿ°µâÕ߇ªìπ√“¬∫ÿ§§≈ ∑—Èߥâ“πÕ“À“√ ·≈–°“√ÕÕ°°”≈—ß°“¬

‰¥âªØ‘∫—µ‘„π°“√ÕÕ°°”≈—ß°“¬®√‘ß ‰¡à„™à‡æ’¬ß§”∫Õ°®“°‡®â“

Àπâ“∑’Ë “∏“√≥ ÿ¢«à“„À⺟âªÉ«¬ÕÕ°°”≈—ß°“¬. πÕ°®“°π’ȺŸâªÉ«¬

¬—߉¥â√—∫§Ÿà¡◊Õ§«“¡√Ÿâ‡°’ˬ«°—∫‚√§‡∫“À«“π·≈–‚√§§«“¡¥—π

‚≈À‘µ Ÿß „Àâ “¡“√∂π”°≈—∫‰ªÕà“π∑∫∑«π∑’Ë∫â“π. √Ÿª·∫∫°“√

®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ„π°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬

‡∫“À«“π·≈–ºŸâªÉ«¬§«“¡¥—π‚≈À‘µ Ÿß®–™à«¬„À⺟âªÉ«¬¡’§«“¡√Ÿâ

‡æ‘Ë¡¢÷Èπ ·≈–¡’∑—°…–‡æ‘Ë¡¢÷Èπ®“°°“√ªØ‘∫—µ‘°“√ÕÕ°°”≈—ß°“¬

´÷Ëß®–‡ªìπ°“√™à«¬ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡Õß„π°“√

§«∫§ÿ¡‚√§‰¥â¥’¢÷Èπ. °“√»÷°…“§√—Èßπ’È¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ

‡ª√’¬∫‡∑’¬∫√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥ ·≈–√–¥—∫·√ߥ—π‡≈◊Õ¥

ºŸâªÉ«¬‡∫“À«“π∑’Ë¡“√—∫∫√‘°“√∑’˧≈‘π‘°‡∫“À«“π·≈–§«“¡¥—π

‚≈À‘µ Ÿß∑’Ë·ºπ°ºŸâªÉ«¬πÕ° ‚√ßæ¬“∫“≈°√–∑ÿà¡·∫π °àÕπ

·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥∫√‘°“√ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈

µπ‡Õß„π‡¥◊Õπ∑’Ë Û ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’Ë ˘.

(4)

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√–‡∫’¬∫«‘∏’»÷°…“

°“√»÷°…“‡ªìπ°“√«‘®—¬°÷Ëß∑¥≈Õß ™π‘¥ one group pre- test-posttest design ¡’®ÿ¥ª√– ß§å‡æ◊ËÕ‡ª√’¬∫‡∑’¬∫√–¥—∫

πÈ”µ“≈„π‡≈◊Õ¥·≈–√–¥—∫·√ߥ—π‡≈◊Õ¥°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫

°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬

‡∫“À«“π ·≈–§«“¡¥—π‚≈À‘µ Ÿß∑’Ë¡“√—∫∫√‘°“√§≈‘π‘°‡∫“À«“π

§«“¡¥—π‚≈À‘µ Ÿß ·ºπ°ºŸâªÉ«¬πÕ°‚√ßæ¬“∫“≈°√–∑ÿà¡·∫π.

°“√»÷°…“‡√‘Ë¡µ—Èß·µà‡¥◊Õπ¡‘∂ÿπ“¬π ÚıÙ˘ ∂÷ß æƒ…¿“§¡

Úıı. °≈ÿࡵ—«Õ¬à“ß∑’Ë»÷°…“‡≈◊Õ°·∫∫‡®“–®ß‰¥â Ú¯¯ §π

®“°ºŸâªÉ«¬‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß∑’Ë¡“√—∫∫√‘°“√∑’Ë

§≈‘π‘°‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß ·ºπ°ºŸâªÉ«¬πÕ°‚√ß æ¬“∫“≈°√–∑ÿà¡·∫𠇪ìπºŸâ∑’ˉ¡à “¡“√∂§«∫§ÿ¡√–¥—∫πÈ”µ“≈

‰¥â, ¡’¿“«–·∑√°´âÕπ∑’ˉ¡à√ÿπ·√ß ·≈–¬‘π¥’‡¢â“√à«¡‚§√ß°“√.

‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√«‘®—¬§√—Èßπ’È ª√–°Õ∫¥â«¬ Ò) ·∫∫

∫—π∑÷°¢âÕ¡Ÿ≈ ª√–°Õ∫¥â«¬ à«π¢âÕ¡Ÿ≈ à«π∫ÿ§§≈, Ú) ·∫∫

∫—π∑÷°√–¥—∫πÈ”µ“≈ ·≈–·√ߥ—π‡≈◊Õ¥, Û) ‡§√◊ËÕß™—ËßπÈ”Àπ—°

¥‘®‘µ—≈™π‘¥¡’∑’Ë«—¥ à«π Ÿß, Ù) ¡“µ√·√ߥ—π‡≈◊Õ¥™π‘¥µ—Èßæ◊Èπ, ı) §Ÿà¡◊ժؑ∫—µ‘ ”À√—∫ºŸâªÉ«¬‡∫“À«“π·≈–ºŸâªÉ«¬§«“¡¥—π

‚≈À‘µ Ÿß, ˆ) §Ÿà¡◊Õ ÿ¢»÷°…“‡√◊ËÕß°“√ÕÕ°°”≈—ß°“¬, ˜) §Ÿà¡◊Õ

°“√„Àâ ÿ¢»÷°…“‡√◊ËÕßÕ“À“√ ”À√—∫ºŸâªÉ«¬‡∫“À«“π / §«“¡¥—π

‚≈À‘µ Ÿß.

°“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈∑”‡ªìπ ı ¢—ÈπµÕπ §◊Õ Ò) «“ß·ºπ

√à«¡°—π√–À«à“ß∑’¡·æ∑¬å 欓∫“≈ π—° ÿ¢»÷°…“ π—°‚¿™π“°√

π—°°“¬¿“æ∫”∫—¥ ·≈–π—°‡∑§π‘§°“√·æ∑¬å, Ú) ‡µ√’¬¡

Õÿª°√≥å·≈–‡§√◊ËÕß¡◊Õ∑’˰≈à“«¢â“ßµâπ, Û) ‡≈◊Õ°°≈ÿࡵ—«Õ¬à“ß µ“¡§ÿ≥ ¡∫—µ‘∑’˰”Àπ¥, Ù) ¥”‡π‘π°“√°—∫°≈ÿࡵ—«Õ¬à“ß ‰¥â·°à

·π–π”µ—« ·®âß«—µ∂ÿª√– ß§å¢Õß°“√«‘®—¬·≈–¢Õ§«“¡√à«¡¡◊Õ,

∫—π∑÷°¢âÕ¡Ÿ≈ à«π∫ÿ§§≈¢Õß°≈ÿࡵ—«Õ¬à“ß, ı) „Àâ∫√‘°“√µ“¡

√Ÿª·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕæ—≤π“»—°¬¿“æ°“√¥Ÿ·≈µπ‡Õß  ”À√—∫ºŸâªÉ«¬‡∫“À«“π·≈–ºŸâªÉ«¬§«“¡¥—π‚≈À‘µ Ÿß ‡¥◊Õπ≈–§√—Èß ª√–°Õ∫¥â«¬ ı.Ò) µ√«®√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥ (ߥՓÀ“√·≈–

πÈ” ¯ ™—Ë«‚¡ß°àÕπµ√«®), ı.Ú) ™—ËßπÈ”Àπ—°, «—¥ à«π Ÿß, «—¥

·√ߥ—π‡≈◊Õ¥, ı.Û) √à«¡°—πª√–‡¡‘πªí≠À“ ÿ¢¿“æ√–À«à“ߺŸâªÉ«¬

·æ∑¬å 欓∫“≈ ·≈–∑’¡ ÿ¢¿“æ, ·≈–√à«¡°—π«“ß·ºπ·°â

ªí≠À“√“¬∫ÿ§§≈, ı.Ù) „Àâ§«“¡√Ÿâ‡√◊ËÕß‚¿™π“°“√‚¥¬π—°

‚¿™π“°“√·≈–π—° ÿ¢»÷°…“√“¬∫ÿ§§≈ §√—Èß≈–ª√–¡“≥ Òı-Û

π“∑’, ı.ı) „Àâ§«“¡√Ÿâ‡√◊ËÕß°“√ÕÕ°°”≈—ß°“¬ ®—¥°‘®°√√¡ÕÕ°

°”≈—ß°“¬°≈ÿà¡§√—Èß≈–ª√–¡“≥ Û π“∑’, ı.ˆ) ∫—π∑÷°¢âÕ¡Ÿ≈

√–¥—∫πÈ”µ“≈·≈–·√ߥ—π‡≈◊Õ¥≈ß„πµ“√“ß∫—π∑÷°¢âÕ¡Ÿ≈.

π—¥ºŸâªÉ«¬∑ÿ°√“¬¡“µ√«®‡°Á∫¢âÕ¡Ÿ≈´È”∑ÿ° Û ‡¥◊ÕπÕ’° Û

§√—Èß ¥—ß√“¬≈–‡Õ’¬¥∑’˪ؑ∫—µ‘„π§√—Èß·√°. (√Ÿª∑’Ë Ò)

°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ à«π∫ÿ§§≈¢Õß°≈ÿࡵ—«Õ¬à“ß „™â°“√

·®°·®ß§«“¡∂’Ë·≈–§à“√âÕ¬≈– ‡ª√’¬∫‡∑’¬∫√–¥—∫πÈ”µ“≈„π

‡≈◊Õ¥·≈–·√ߥ—π‡≈◊Õ¥°àÕπ·≈–À≈—ß°“√„™â√Ÿª·∫∫°“√®—¥

∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬‡∫“

À«“π·≈–ºŸâªÉ«¬§«“¡¥—π‚≈À‘µ Ÿß.

º≈°“√«‘®—¬

°≈ÿࡵ—«Õ¬à“ߺŸâªÉ«¬‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß∑’Ë¡’

§ÿ≥ ¡∫—µ‘∑’˰”Àπ¥·≈–¬‘π¥’‡¢â“√à«¡‚§√ß°“√®”π«π Ú¯¯ §π

‡ªìπ‡æ»™“¬ ¯˜ §π §‘¥‡ªìπ√âÕ¬≈– Û.Ú ·≈–‡æ»À≠‘ß ÚÒ

§π §‘¥‡ªìπ√âÕ¬≈– ˆ˘.¯ °≈ÿࡵ—«Õ¬à“ß¡’Õ“¬ÿ‡©≈’ˬ ıˆ.˜Ò ªï Õ“¬ÿπâÕ¬∑’Ë ÿ¥ ÚÚ ªï Õ“¬ÿ¡“°∑’Ë ÿ¥ ¯Ú ªï. º≈°“√µ√«®

√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥„π™à«ß°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥

∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬‡∫“

À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß æ∫«à“√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥°àÕπ

·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√

¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬„π‡¥◊Õπ∑’Ë Û ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’ˢ

‰¥â§à“‡©≈’ˬ‡∑à“°—∫ ÚÒ.¯˜ ¡°./¥≈. (§à“‡∫’ˬ߇∫π¡“µ√∞“π

= ıˆ.ÒÚ), Ò˘˘.˜˘ ¡°./¥≈. (§à“‡∫’ˬ߇∫π¡“µ√∞“π = ıı.¯˘), Òı¯.ÛÚ ¡°./¥≈. (§à“‡∫’ˬ߇∫π¡“µ√∞“π = ıÛ.ˆı), ÒÙ˜.˘Ò ¡°./¥≈. (§à“‡∫’ˬ߇∫π¡“µ√∞“π = ı.Ù¯) µ“¡≈”¥—∫

(√Ÿª∑’Ë Ú) ´÷Ëß√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√

®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬„π

‡¥◊Õπ∑’Ë Û ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’ˢ ¡’§«“¡·µ°µà“ß°—πÕ¬à“ß¡’

π—¬ ”§—≠∑“ß ∂‘µ‘ (‡Õø = ˜.Ò¯, §à“æ’ = .).

º≈°“√µ√«®«—¥·√ߥ—π‡≈◊Õ¥°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√

®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬‡∫“

(5)

ÛÒı

À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß æ∫«à“√–¥—∫·√ߥ—π‡≈◊Õ¥ ‘¬å ‚∑≈‘§

°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ

°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬„π‡¥◊Õπ∑’Ë Û ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’Ë

˘ ‰¥â§à“‡©≈’ˬ‡∑à“°—∫ ÒÙ¯.ıÒ ± ÒÚ.ˆ ¡¡.ª√Õ∑, ÒÛÒ.Ò

± Òˆ.ˆ ¡¡.ª√Õ∑, ÒÛÒ.˜Ù ± ÒÛ.ÚÒ ¡¡.ª√Õ∑, ·≈–

ÒÛÒ.¯ ± ÒÛ.ÚÚ ¡¡.ª√Õ∑ µ“¡≈”¥—∫ ·≈–æ∫«à“√–¥—∫

·√ߥ—π‡≈◊Õ¥ ‘¬å ‚∑≈‘§°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥∫√‘°“√

‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬„π‡¥◊Õπ∑’Ë Û

‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’ˢ ¡’§«“¡·µ°µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠

∑“ß ∂‘µ‘ (‡Õø= ˆ.˘ı, §à“æ’ = .).

º≈°“√µ√«®«—¥·√ߥ—π‡≈◊Õ¥°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√

®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬‡∫“

À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß æ∫«à“·√ߥ—π‡≈◊Õ¥‰¥·Õ ‚∑≈‘§

°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ

°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬„π‡¥◊Õπ∑’Ë Û, ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ

∑’Ë ˘ ‰¥â§à“‡©≈’ˬ‡∑à“°—∫ ˘¯.¯ı ± ˘.ˆ ¡¡.ª√Õ∑, ˜¯.˘ˆ ±

√Ÿª∑’Ë Ò ·ºπ¿Ÿ¡‘°“√®—¥∫√‘°“√

Ú

Ò˘

Ò¯ı Ò¯

Ò˜ı Ò˜

Òˆı Òˆ

Òıı Òı

ÒÙı ÒÙ

ÒÛı

√Ÿª∑’Ë Ú §à“‡©≈’ˬ√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√

®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æª≈“¬‡¥◊Õπ∑’Ë Û ∑’Ë ˆ ·≈–

∑’Ë ˘

ÒÙ˜.˘Ò

Ò Û ˆ ˘ ‡¥◊Õπ

Òı¯.ÛÚ Ò˘˘.˘˜

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∑”∫—µ√

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«—¥·√ߥ—π‡≈◊Õ¥

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„π‡≈◊Õ¥ Ÿß

√—∫§”·π–π”°“√

∫√‘‚¿§Õ“À“√®“°

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ºŸâªÉ«¬°≈—∫∫â“π  “∏‘µ + Ωñ°ªØ‘∫—µ‘°“√ÕÕ°°”≈—ß°“¬

‚¥¬π—°°“¬¿“æ

§à“‡©≈’ˬ√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥

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ÛÒˆ

˘.ÙÚ ¡¡.ª√Õ∑, ˜˘.ÚÙ ± ¯.ˆÙ ¡¡.ª√Õ∑, ·≈– ˜˘.Û¯

± ¯.¯ı ¡¡.ª√Õ∑ µ“¡≈”¥—∫ ‚¥¬æ∫«à“§«“¡·µ°µà“ߢÕß

√–¥—∫·√ߥ—π‡≈◊Õ¥‰¥·Õ ‚∑≈‘§°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥

∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬„π‡¥◊Õπ∑’Ë Û ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’Ë ˘ ‰¡à¡’§«“¡ ”§—≠∑“ß ∂‘µ‘ (‡Õø=

Ú.ı¯, §à“æ’ =.Ò¯˘).

«‘®“√≥å

°“√»÷°…“«‘®—¬§√—Èßπ’ȇªìπ·∫∫°÷Ëß∑¥≈Õß ∑’ˉ¡à¡’°≈ÿà¡

‡ª√’¬∫‡∑’¬∫ ‡π◊ËÕß®“°¢âÕ®”°—¥®“°®”π«πºŸâ‡¢â“√à«¡‚§√ß°“√.

‰¥â®—¥°‘®°√√¡„ÀⷰຟâªÉ«¬∑’ˇ¢â“‚§√ß°“√∑ÿ° Û ‡¥◊Õπ ¡’®ÿ¥

ª√– ß§å‡æ◊ËÕ‡ª√’¬∫‡∑’¬∫√–¥—∫πÈ”µ“≈„π‡≈◊Õ¥ ·≈–√–¥—∫·√ß

¥—π‡≈◊Õ¥°àÕπ·≈–À≈—ß„™â√Ÿª·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡

»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬‡∫“À«“π·≈–§«“¡¥—π

‚≈À‘µ Ÿß∑’Ë¡“√—∫∫√‘°“√∑’˧≈‘π‘°‡∫“À«“π§«“¡¥—π‚≈À‘µ Ÿß

·ºπ°ºŸâªÉ«¬πÕ°‚√ßæ¬“∫“≈°√–∑ÿà¡·∫π. √Ÿª·∫∫°“√®—¥

∫√‘°“√„À⺟âªÉ«¬‰¥â√—∫√Ÿâ¿“«– ÿ¢¿“æ·≈–ªí≠À“ ÿ¢¿“æ¢Õß µπ‡Õß®“°°“√‰¥â¡’ à«π√à«¡„π°“√ª√–‡¡‘πªí≠À“ ÿ¢¿“æ¢Õß µπ‡Õß ·≈–‰¥â√à«¡«“ß·ºπ·°â‰¢ªí≠À“ ÿ¢¿“æ¢Õßµπ‡Õß

‚¥¬¡’∑’¡·æ∑¬å欓∫“≈ π—° ÿ¢»÷°…“ ·≈–π—°°“¬¿“æ∫”∫—¥

„Àâ§”·π–π”∑”„À⺟âªÉ«¬¡’‚Õ°“ ‰¥â√—∫§«“¡√Ÿâ‡°’ˬ«°—∫°“√¥Ÿ·≈

 ÿ¢¿“æµπ‡Õß ·≈–√—∫√Ÿâªí≠À“ ÿ¢¿“æ¢Õßµπ‡Õß„π à«π¢Õß

°“√«“ß·ºπ„π°“√·°â‰¢ªí≠À“. ®“°°“√¡’ à«π√à«¡„π°“√

ª√–‡¡‘πªí≠À“ ÿ¢¿“æ¢Õßµπ‡Õß√“¬∫ÿ§§≈∑”„Àâ√–¥—∫πÈ”µ“≈

„π‡≈◊Õ¥·≈–√–¥—∫·√ߥ—π‡≈◊Õ¥ ‘¬å ‚∑≈‘§ °àÕπ·≈–À≈—ß„™â√Ÿª

·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕß ºŸâªÉ«¬„π‡¥◊Õπ∑’Ë Û ‡¥◊Õπ∑’Ë ˆ ·≈–‡¥◊Õπ∑’Ë ˘ ¡’§«“¡·µ°µà“ß

°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘. ‡π◊ËÕß®“°‡∫“À«“π·≈–§«“¡¥—π

‚≈À‘µ Ÿß‡ªìπ‚√§‡√◊ÈÕ√—ß∑’˵âÕß√—°…“µ‘¥µàÕ°—π‡ªìπ‡«≈“π“π À√◊Õ µ≈Õ¥™’«‘µ ¥—ßπ—Èπ‡æ◊ËÕ°“√∫”∫—¥Õ“°“√‚√§ ·≈–ªÑÕß°—π Õ—πµ√“¬®“°¿“«–·∑√°´âÕπ ∑’ËÕ“®®–‡°‘¥¢÷Èπ‰¥â ºŸâ∑’ˇªìπ‚√§

‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß®”‡ªìπµâÕ߉¥â√—∫§«“¡√Ÿâ·≈–§”

·π–π”‡√◊ËÕß°“√∫√‘‚¿§Õ“À“√Õ¬à“ß∂Ÿ°µâÕß ÕÕ°°”≈—ß°“¬

Õ¬à“߇À¡“– ¡ ∫√‘‚¿§Õ“À“√À√◊Õ°‘𬓩’¥¬“Õ¬à“ß∂Ÿ°µâÕß

√«¡∑—È߇æ‘Ë¡∑—°…–°“√¥Ÿ·≈µπ‡Õß. Õ“À“√‡ªìπÀ—«„® ”§—≠∑’Ë

™à«¬„Àâ°“√√—°…“‰¥âº≈∑’Ë¥’¬‘Ëߢ÷Èπ. ºŸâ∑’ˇªìπ‚√§‡∫“À«“π§«√

‡√’¬π√Ÿâ∂÷ß°“√∫√‘‚¿§Õ“À“√‡æ◊ËÕ ÿ¢¿“æ ‡æ‘Ë¡§ÿ≥§à“·≈–§«“¡

 ”§—≠¢ÕßÕ“À“√, ‡√’¬π√Ÿâ°“√°‘πÕ“À“√∑’Ë∂Ÿ°µâÕß, ‡≈◊Õ°Õ“À“√

∑’Ë¥’¡’§ÿ≥¿“æ,  “¡“√∂ª√–‡¡‘πª√‘¡“≥Õ“À“√∑’Ë∫√‘‚¿§, À≈’°

‡≈’ˬßÕ“À“√∑’Ë¡’º≈‡ ’¬µàÕ√à“ß°“¬ ´÷Ëß®– àߺ≈∂÷ß°“√≈¥§«“¡

√ÿπ·√ߢÕß‚√§ µ≈Õ¥®π≈¥ªí≠À“‚√§·∑√°´âÕπ∑’ËÕ“®‡°‘¥

¢÷Èπ‰¥â ·≈–∑”„À⺟â∑’ˇªìπ‚√§‡∫“À«“π¡’§ÿ≥¿“æ™’«‘µ∑’Ë¥’„π  —ß§¡(ÒÒ). ≈— §å(ÒÚ) ‰¥âÕ∏‘∫“¬‰«â«à“°“√¡’ªØ‘ —¡æ—π∏å°—∫‡®â“- Àπâ“∑’˺Ÿâ„Àâ∫√‘°“√ ÿ¢¿“æ¡’Õ‘∑∏‘æ≈µàÕ°“√ à߇ √‘¡ ÿ¢¿“æ. °“√

‰¥â¡’‚Õ°“ √—∫√Ÿâªí≠À“ ÿ¢¿“æ¢Õßµπ‡Õß ‰¥â¡’ à«π√à«¡

«“ß·ºπ·°âªí≠À“ ·≈–‰¥â√—∫§”·π–π”·≈–°”≈—ß„®‡ªìπ°“√

 √â“ß§«“¡¡—Ëπ„®«à“ºŸâªÉ«¬¡’»—°¬¿“æ “¡“√∂¥Ÿ·≈µπ‡Õ߉¥â  Õ¥§≈âÕß°—∫°“√«‘®—¬¢Õß ®‘√“¿√≥å ©≈“πÿ«—≤πå(ÒÛ) ·≈– ¥“√≥’

 ÿ«¿“æ(ÒÙ) ·≈–‡ªìπ‰ªµ“¡∑’Ë ‡æπ‡¥Õ√å(ÒÚ) ‰¥âÕ∏‘∫“¬‰«â«à“ °“√

√—∫√Ÿâ»—°¬¿“æ¢Õßµπ‡Õß¡’Õ‘∑∏‘æ≈‚¥¬µ√ßµàÕ°“√°√–∑”

惵‘°√√¡ à߇ √‘¡ ÿ¢¿“æ ∑”„Àâ∫ÿ§§≈‡°‘¥§«“¡‡™◊ËÕ¡—Ëπ«à“

µπ‡Õß¡’§«“¡ “¡“√∂·≈–¡’∑—°…–´÷Ë߇ªìπ·√ß®Ÿß„®„Àâ∫ÿ§§≈

ª√—∫‡ª≈’Ë¬πæƒµ‘°√√¡.

Õ¬à“߉√°Áµ“¡°“√»÷°…“„π§√—Èßπ’Ȭ—ß¡’¢âÕ®”°—¥À≈“¬

ª√–°“√ ‰¥â·°à °≈ÿࡵ—«Õ¬à“ß∑’Ë„™â„π°“√»÷°…“‡ªìπ°≈ÿà¡∑’Ë

‡µÁ¡„®‡¢â“√à«¡‚§√ß°“√ Õ“®‡ªìπªí®®—¬Àπ÷Ëß∑’Ë¡’º≈µàÕ»—°¬¿“æ

°“√¥Ÿ·≈µπ‡ÕߢÕߺŸâªÉ«¬ ¥—ßπ—Èπ §«√¡’°“√»÷°…“°“√„™â

√Ÿª·∫∫°“√®—¥∫√‘°“√‡æ◊ËÕ à߇ √‘¡»—°¬¿“æ°“√¥Ÿ·≈µπ‡ÕߢÕß ºŸâªÉ«¬‡∫“À«“π·≈–§«“¡¥—π‚≈À‘µ Ÿß ‚¥¬¡’°≈ÿࡇª√’¬∫‡∑’¬∫

§◊Õ°≈ÿà¡§«∫§ÿ¡·≈–°≈ÿà¡∑¥≈Õß ·≈–§«√¡’°“√«‘®—¬´È”„π°≈ÿà¡

µ—«Õ¬à“ßÕ◊Ë𠇙àπ°≈ÿࡺŸâªÉ«¬‚√§‡√◊ÈÕ√—ßÕ◊Ëπ Ê ¥â«¬.

‡Õ° “√Õâ“ßÕ‘ß

Ò. «‘∑¬“ »√’¡“¥“ (∫√√≥“∏‘°“√). °“√¥Ÿ·≈√—°…“ºŸâªÉ«¬‡∫“À«“π. æ‘¡æå

§√—Èß∑’Ë Û. °√ÿ߇∑æ¡À“π§√: ‚√ßæ‘¡æå·Ààß®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬;

ÚıÙı.

(7)

ÛÒ˜

Ú. «’√æ—π∏å ‚¢«‘±Ÿ√‡°’¬√µ‘. °“√¥Ÿ·≈°“√‡∫“À«“π. ‡Õ° “√ª√–°Õ∫°“√

Õ∫√¡√–¬– —Èπ§√—Èß∑’Ë Ú ‡√◊ËÕß°“√¥Ÿ·≈¿“«–‡∫“À«“π, ÚÒ-Úı ¡’π“§¡

ÚıÙ¯ ≥ ‚√ßæ¬“∫“≈®ÿÓ≈ß°√≥å °√ÿ߇∑æ¡À“π§√, ®—¥‚¥¬ “¢“

µàÕ¡‰√â∑àÕ·≈–‡¡µ“∫Õ≈‘ ¡ ¿“§«‘™“Õ“¬ÿ√»“ µ√å.

Û. Siitonen OI, Niskanen LK, Laakso M, Siitonen JT, PyoralaK.

Lower-extremity amputation in diabetic and nondiabetic patients.

A population-based study in eastern Finland. Diabetes Care 1993;

16:16-20.

Ù.  ÿ√‡°’¬√µ‘ Õ“™“π“πÿ¿“æ. µ”√“°“√µ√«®√—°…“‚√§∑—Ë«‰ª. æ‘¡æå§√—Èß

∑’Ë Û. °√ÿ߇∑æ¡À“π§√: Õÿ…“°“√æ‘¡æå; ÚıÙÛ.

ı. ‡ «° «’√–‡°’¬√µ‘. ªí≠À“¥â“π‡¡µ“∫Õ≈‘°. «“√ “√‡«™ªØ‘∫—µ‘·≈–

°“√„™â¬“ ÚıÙ˘; ÚÚ:ıÒ-ˆ.

ˆ. Abizaid A, Kormowski R, Mintz GS, Hong MK, Abizaid AS, Mehran R, et al. The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation. J Am Coll Cardiol 1998; 32:584-9.

˜. Cleveland Clinic. Metabolic syndrome. 2003. [Retrieved March 3, 2005]; Arailable from : URL : http://www.clevelandclinic.org/health/

¯. Lawrence VJ, Kopelman PG. Medical consequences of obesity.

Clin Dermatol 2004; 22:296-302.

˘. Segal KR. Type 2 diabetes and disease management: exploring the connections. Dis Manag 2004; 7(Suppl 1): S11-22.

Ò. æ‘π‘® °ÿ≈«≥‘™¬å. °“√ à߇ √‘¡ ÿ¢¿“æ‚¥¬°“√ÕÕ°°”≈—ß°“¬·≈–°“√

‚¿™π“°“√. ‡Õ° “√ √ÿª°“√ª√–™ÿ¡«‘™“°“√ª√–®”ªï √“™«‘∑¬“≈—¬

Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬ æ.». ÚıÙı.

ÒÒ. American Diabetes Association. Dyslipidemia management in adults with diabetes. Diabetes Care 2004; 27(suppl. 1): S 68-71.

ÒÚ. Pender NJ. Health promotion in nursing practice. Stanford, CT:

Appleton & Lange; 1996.

ÒÛ. ®‘√“¿√≥å ©≈“πÿ«—≤πå. °“√»÷°…“惵‘°√√¡ à߇ √‘¡ ÿ¢¿“æ¢ÕߺŸâ Ÿß Õ“¬ÿ∑’˪«¥À≈—ß. «‘∑¬“π‘æπ∏åª√‘≠≠“欓∫“≈»“ µ√¡À“∫—≥±‘µ,

∫—≥±‘µ«‘∑¬“≈—¬ ¡À“«‘∑¬“≈—¬¡À‘¥≈, ÚıÙÒ.

ÒÙ. ¥“√≥’  ÿ«¿“æ. ªí®®—¬∑’Ë¡’Õ‘∑∏‘æ≈µàÕ°“√ à߇ √‘¡ ÿ¢¿“æ¢Õß§πß“π  µ√’µ—Èß§√√¿å∑’Ë∑”ß“π„π‚√ßß“πÕÿµ “À°√√¡ ∑’Ë¡“√—∫∫√‘°“√∑’ËÀπ૬

Ω“°§√√¿å. «‘∑¬“π‘æπ∏åª√‘≠≠“欓∫“≈»“ µ√¥ÿ…Æ’∫—≥±‘µ, ∫—≥±‘µ

«‘∑¬“≈—¬ ¡À“«‘∑¬“≈—¬¡À‘¥≈, ÚıÙÒ.

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