π‘æπ∏åµâπ©∫—∫
Original Article
∫∑§—¥¬àÕ °“√»÷°…“‡™‘ßæ√√≥π“ (descriptive study) æ∫«à“ ¡’ºŸâªÉ«¬∑’Ë¢÷Èπ∑–‡∫’¬π„π§≈‘π‘°«—≥‚√§‚√ß欓∫“≈
°”·æ߇æ™√ ªïß∫ª√–¡“≥ 2547-2549 ¡’®”π«π 858 √“¬ ‚¥¬¡’®”π«πºŸâªÉ«¬«—≥‚√§ªÕ¥√“¬„À¡à‡ ¡À–
∫«° ®”π«π 341 √“¬ √âÕ¬≈– 39.7 à«π„À≠à‡ªìπ‡æ»™“¬ √âÕ¬≈– 71.3 ¡’Õ“¬ÿ√–À«à“ß 3 ∂÷ß 85 ªï Õ“¬ÿ‡©≈’ˬ
47.4 ªï Õ“™’æ√—∫®â“ß¡“°∑’Ë ÿ¥ √âÕ¬≈– 52.5 √Õß≈ß¡“Õ“™’懰…µ√°√√¡ √âÕ¬≈– 18.2 ”À√—∫º≈∑“ß°“√
√—°…“‚¥¬„™â Ÿµ√¬“ CAT1 (2HRZE/4HR) æ∫Õ—µ√“‡ ¡À–ª√“»®“°‡™◊ÈÕ‡¡◊ËÕ ‘Èπ ÿ¥√–¬–‡¢â¡¢âπ (conversion rate) √âÕ¬≈– 79.2 „π¢≥–∑’ËÕ—µ√“°“√√—°…“À“¬ (success rate) √âÕ¬≈– 69.2 Õ—µ√“°“√¢“¥¬“ (default rate) √âÕ¬≈– 2.4 Õ—µ√“°“√√—°…“≈⡇À≈« (failure rate) √âÕ¬≈– 5.3 ·≈–Õ—µ√“°“√µ“¬ (death rate)
√âÕ¬≈– 12.8 µ“¡≈”¥—∫
º≈°“√»÷°…“· ¥ß„Àâ‡ÀÁπ«à“°“√§âπÀ“√“¬ªÉ«¬·≈–°“√¥Ÿ·≈√—°…“ ‚¥¬‡©≈’ˬ∑—Èß 3 ªï ¬—ß¡’º≈µË”°«à“
‡°≥±å¡“µ√∞“π¢ÕßÕߧ尓√Õπ“¡—¬‚≈°∑’Ë°”À𥉫â (85%) Õ“®‡π◊ËÕß®“°¡’®”π«πºŸâªÉ«¬‡ ’¬™’«‘µ ‚¥¬
‡©æ“–ºŸâªÉ«¬«—≥‚√§∑’Ë¡’‚√§‡Õ¥ å√à«¡ ®“°°“√¬â“¬∂‘Ëπ∞“π ·≈–™√“¿“æ °“√¢“¥§π¥Ÿ·≈∑—Èß®“°§√Õ∫§√—«·≈–
™ÿ¡™π ¥—ßπ—Èπ§«√‡πâπ°“√¡’ à«π√à«¡¢Õß™ÿ¡™π„Àâ¡“°¢÷È𠇙àπ °“√Õ∫√¡·°ππ”À¡Ÿà∫â“π °“√‡æ‘Ë¡§«“¡‡¢â¡
¢âπ„π°“√µ‘¥µ“¡ºŸâªÉ«¬À≈—ß®“°°≈—∫‡¢â“ Ÿà™ÿ¡™π °“√ª√– “πß“π°—∫‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢ Õ“ “ ¡—§√
“∏“√≥ ÿ¢ ‡æ◊ËÕ§«∫§ÿ¡ ªÑÕß°—π°“√·æ√à°√–®“¬‡™◊ÈÕ ·≈–¥Ÿ·≈ à߇ √‘¡„À⺟âªÉ«¬„À¡à‰¥â√—∫¬“Õ¬à“ߧ√∫∂â«π
§” ”§—≠: °“√§«∫§ÿ¡«—≥‚√§, «—≥‚√§ªÕ¥
º≈°“√¥”‡π‘πß“π§«∫§ÿ¡«—≥‚√§
„π‚√ß欓∫“≈°”·æ߇æ™√
µÿ≈“§¡ 2547 - °—𬓬π 2549
√®π“ ¢Õπ∑Õß
°≈ÿà¡ß“πÕ“¬ÿ√°√√¡ ‚√ß欓∫“≈°”·æ߇æ™√
∫∑π”
«—≥‚√§‡ªìπ‚√§µ‘¥µàÕ∑’ˬ—߇ªìπªí≠À“ “∏“√≥ ÿ¢∑’Ë ”§—≠ ‡ªì𠓇Àµÿ¢Õß°“√ªÉ«¬·≈–°“√µ“¬„πÀ≈“¬ Ê ª√–‡∑»∑—Ë«‚≈° Õߧ尓√Õπ“¡—¬‚≈°(1) √“¬ß“π«à“ 1 „π
3 ¢Õߪ√–™“°√∑—Ë«‚≈°¡’°“√µ‘¥‡™◊ÈÕ«—≥‚√§ §«“¡™ÿ°
(prevalence) ¢ÕߺŸâªÉ«¬«—≥‚√§¡’ª√–¡“≥ 14.6 ≈â“π§π
¡’ºŸâªÉ«¬√“¬„À¡à (incidence) ª√–¡“≥ 8.6 ≈â“π§π (§.».
2005) ‡°◊Õ∫§√÷ËßÀπ÷Ëß ª√–¡“≥ 3.9 ≈â“π§π‡ªìπºŸâªÉ«¬
Journal of Health Science 2008 Vol. 17 No. 4
538
∑’Ë°”≈—ß·æ√à‡™◊ÈÕ ·≈–Õ¬Ÿà„πª√–‡∑»°”≈—ßæ—≤π“ ¡’ºŸâªÉ«¬
«—≥‚√§‡ ’¬™’«‘µªï≈– ª√–¡“≥ 1.7 ≈â“π§π √âÕ¬≈– 98 Õ¬Ÿà„πª√–‡∑»∑’ˬ“°®π ª√–‡∑»‰∑¬¡’ºŸâªÉ«¬«—≥‚√§™ÿ°
‡ªìπÕ—π¥—∫∑’Ë 18 ¢Õß‚≈° „π®”π«π 22 ª√–‡∑» ∑’Ë¡’
ªí≠À“¥â“π«—≥‚√§ Ÿß §“¥«à“®–¡’®”π«πºŸâªÉ«¬√“¬
„À¡àª√–¡“≥ 91,000 √“¬/ªï (142 µàÕ· πª√–™“°√)
·≈–ª√–¡“≥ 40,000 √“¬ ‡ªìπºŸâªÉ«¬∑’Ë¡’‡ ¡À–∫«° (63 µàÕ· πª√–™“°√)
∂“π°“√≥å«—≥‚√§„πª√–‡∑»‰∑¬ ®“° ∂‘µ‘¢Õß ”π—°√–∫“¥«‘∑¬“ °√¡§«∫§ÿ¡‚√§ æ.». 2547, 2548
·≈– 2549 æ∫«à“¡’ºŸâªÉ«¬«—≥‚√§√“¬„À¡à ®”π«π 31,821
√“¬ ®”π«π 27,245 √“¬ ·≈– 22,705 √“¬ ‡ ’¬™’«‘µ
®”π«π 182 √“¬, 150 ·≈– 131 √“¬ µ“¡≈”¥—∫(2,3) ®÷ß
¡’ ∂‘µ‘®“°«—≥‚√§ ŸßÕ¬Ÿà„π ‘∫Õ—π¥—∫·√°¢ÕßÕ—µ√“µ“¬
®“° “‡Àµÿµà“ß Ê ·≈– Ÿß∑’Ë ÿ¥„π‚√§µ‘¥‡™◊ÈÕ °“√µ√«®
À“ºŸâªÉ«¬√“¬„À¡à °“√√—°…“¥â«¬√–∫∫¬“√–¬– —Èπ¡’
§«“¡§√Õ∫§≈ÿ¡‡æ’¬ß√âÕ¬≈– 50-60 ¢ÕߺŸâªÉ«¬«—≥‚√§
∑—Èߪ√–‡∑» ·≈–æ∫«à“¬—ß¡’ªí≠À“‡°’ˬ«°—∫Õ—µ√“°“√‰¥â
√—∫°“√√—°…“§√∫∂â«π ·≈–°“√√—°…“À“¬ ‡æ’¬ß√âÕ¬≈–
50-70 ·≈–‡√‘Ë¡¡’ªí≠À“®“°°“√‡æ‘Ë¡¢÷Èπ¢ÕߺŸâµ‘¥‡™◊ÈÕ‡Õ¥ å
‚¥¬‡©æ“–„π‡¢µ∑’Ë¡’°“√√–∫“¥¢Õß‚√§‡Õ¥ å Ÿß ‡™àπ ¿“§
‡Àπ◊ÕµÕπ∫π(3)
”À√—∫®—ßÀ«—¥°”·æ߇æ™√ Õ¬Ÿà„π¿“§‡Àπ◊ÕµÕπ
≈à“ߢÕߪ√–‡∑» æ∫ºŸâªÉ«¬«—≥‚√§ æ.». 2547-2549
®”π«π 1,099 √“¬(2) ‚¥¬‡ªìπºŸâªÉ«¬∑’ˇ¢â“√—∫°“√√—°…“
·≈–≈ß∑–‡∫’¬πºŸâªÉ«¬„π§≈‘π‘°«—≥‚√§ ‚√ß欓∫“≈
°”·æ߇æ™√ à«π„À≠à‡ªìπºŸâªÉ«¬∑’Ë¡’¿Ÿ¡‘≈”‡π“Õ¬Ÿà„π
®—ßÀ«—¥°”·æ߇æ™√ ®”π«π 855 √“¬ ºŸâªÉ«¬µ√«®
‡ ¡À–æ∫‡™◊ÈÕ√“¬„À¡à ®”π«π 341 √“¬ ∑’˺à“π¡“‚√ß- 欓∫“≈°”·æ߇æ™√ ¡’π‚¬∫“¬°“√¥”‡π‘πß“π§≈‘π‘°
«—≥‚√§ ‡æ◊ËÕ°“√¥Ÿ·≈√—°…“欓∫“≈ºŸâªÉ«¬«—≥‚√§
‡ªìπ°“√‡©æ“–¥”‡π‘πß“π„π√Ÿª·∫∫§≈‘π‘°«—≥‚√§¡’°“√
ª√– “πß“π°“√∑”ß“π√à«¡°—π√–À«à“ß·æ∑¬åÕ“¬ÿ√°√√¡
欓∫“≈ª√–®”§≈‘π‘°«—≥‚√§ ß“πºŸâªÉ«¬πÕ° °≈ÿà¡ß“π
‡«™°√√¡ —ߧ¡ ‚√ß欓∫“≈™ÿ¡™π ·≈–‡®â“Àπâ“∑’Ë
∂“π’Õπ“¡—¬ Õ¬à“߉√°Áµ“¡°“√¥”‡π‘πß“π∑’˺à“π¡“ æ∫
«à“¬—ß¡’®ÿ¥ÕàÕπ¢âÕ∫°æ√àÕßµà“ß Ê àߺ≈„ÀâÕ—µ√“§«“¡
”‡√Á®„π°“√¥Ÿ·≈ºŸâªÉ«¬«—≥‚√§¬—߉¡àºà“π‡°≥±å¢Õß Õߧ尓√Õπ“¡—¬‚≈° ¥—ßπ—Èπ®÷ß»÷°…“º≈°“√¥”‡π‘πß“π
§≈‘π‘°«—≥‚√§ ·≈–°“√√—°…“ºŸâªÉ«¬«—≥‚√§¥â«¬ Ÿµ√¬“
CAT1(2HRZE/4HR) ‡æ◊ËÕ«‘‡§√“–Àåª√—∫ª√ÿß·°â ‰¢ °“√
¥”‡π‘πß“π„Àâ¡’ª√– ‘∑∏‘¿“欑Ëߢ÷ÈπµàÕ‰ª
«‘∏’°“√»÷°…“
√–‡∫’¬∫«‘∏’°“√»÷°…“
‡ªìπ°“√»÷°…“¬âÕπÀ≈—ß (retrospective descrip- tive study) ‚¥¬‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈ ®“°ºŸâªÉ«¬∑’Ë¢÷Èπ
∑–‡∫’¬π„À¡à¢Õߪïß∫ª√–¡“≥ 2547-2549 ‡æ◊ËÕª√–
‡¡‘πº≈°“√¥”‡π‘πß“π§«∫§ÿ¡«—≥‚√§ §≈‘π‘°«—≥‚√§„π
‚√ß欓∫“≈°”·æ߇æ™√
ª√–™“°√∑’Ë»÷°…“
§◊Õ ºŸâªÉ«¬«—≥‚√§‡ ¡À–∫«°√“¬„À¡à∑ÿ°√“¬∑’Ë¢÷Èπ
∑–‡∫’¬π ªïß∫ª√–¡“≥ 2547-2549
°“√¥”‡π‘πß“π„π§≈‘π‘°«—≥‚√§
∑ÿ°«—πæƒÀ— ∫¥’ ™à«ß‡™â“ 8.00-12.00 π. „π°√≥’
∑’˺ŸâªÉ«¬µ√«®æ∫®“°·ºπ°ºŸâªÉ«¬πÕ°„π«—πÕ◊Ëπ Ê ®–¡’
欓∫“≈ª√–®”§≈‘π‘°‡ªìπºŸâ≈ß∑–‡∫’¬π
¢—ÈπµÕπ°“√∑”ß“π Õ¬à“ß —߇¢ª §◊Õ
1. ºŸâªÉ«¬¬◊Ëπ ¡ÿ¥ª√–®”µ—«µàÕ欓∫“≈ª√–®”§≈‘π‘°
2. ™—ËßπÈ”Àπ—° «—¥§«“¡¥—π‚≈À‘µ 3. æ∫欓∫“≈ª√–®”§≈‘π‘°«—≥‚√§
- §âπ‡«™√–‡∫’¬πºŸâªÉ«¬πÕ°
- àßµ√«®∑“ßÀâÕߪؑ∫—µ‘°“√µà“ßÊ ‡™àπ ‡ ¡À–, CBC, BUN, Creatinine, LFT
- √—∫∫—µ√§‘«„π°√≥’‡®“–‡≈◊Õ¥∑—Ë«‰ª ·≈–‰¥â√—∫
°“√„À⧔ª√÷°…“ ≈ß≈“¬¡◊Õ™◊ËÕ„π„∫¬‘π¬Õ¡ °√≥’‡®“–
‡≈◊Õ¥‡æ◊ËÕ§âπÀ“ HIV
- àßµ√«®¿“æ∂à“¬√—ß ’∑√«ßÕ°
4. ‡ ¢â “ √— ∫ øí ß ° “ √ Õ π ÿ ¢ »÷ ° … “ ® “ ° æ ¬ “ ∫ “ ≈ ª√–®”§≈‘π‘°‚¥¬‡©æ“–ºŸâªÉ«¬√“¬„À¡à∑’Ë¡’º≈‡ ¡À–∫«°
À√◊Õ¿“æ√—ß ’ªÕ¥‡¢â“‰¥â°—∫«—≥‚√§·≈–·æ∑¬å‰¥â«‘π‘®©—¬
·≈â«
5. æ∫欓∫“≈ª√–®”§≈‘π‘°
- ®à“¬¬“µàÕ„π°√≥’ºŸâªÉ«¬√—∫¬“‡¥‘¡ æ√âÕ¡«—π π—¥ºŸâªÉ«¬§√—ÈßµàÕ‰ª
6. àßæ∫·æ∑¬å °√≥’‰¥â√—∫°“√µ√«®‡≈◊Õ¥ µ√«®
‡ ¡À– ‰¥â√—∫º≈¢â“߇§’¬ß®“°°“√°‘𬓠À√◊Õ°√≥’º‘¥ª°µ‘
‰¥â·°à¡’Õ“°“√§≈◊Ëπ‰ â Õ“‡®’¬π¡“° º◊Ëπ§—π ·æ⬓ ÀŸÕ◊ÈÕ µ“∫Õ¥ ’ ª«¥µ“¡¢âÕ
7. æ∫欓∫“≈ª√–®”§≈‘π‘°Õ’°§√—ÈßÀ≈—ß®“°æ∫
ᾷŒ
8. °√≥’ºŸâªÉ«¬ ‰¡à¡“µ“¡π—¥ ‚∑√»—æ∑嵑¥µ“¡ ·®âß
‡®â“Àπâ“∑’Ë ∂“π’Õπ“¡—¬„π‡¢µ√—∫º‘¥™Õ∫ ª√– “π Àπà«¬ß“π‡«™°√√¡ —ߧ¡ «‘∑¬ÿµ‘¥µ“¡ ·≈– àß®¥À¡“¬
µ“¡
°“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈
‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈®“° ¡ÿ¥∑–‡∫’¬πºŸâªÉ«¬«—≥‚√§
· ≈ – ¡ÿ ¥ ∫— π ∑÷ ° ° “ √ ‡ ®Á ∫ ªÉ « ¬ ¢ Õ ß ºŸâ ªÉ « ¬ · µà ≈ – √ “ ¬ ªïß∫ª√–¡“≥ 2547-2549
°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈
°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬„™â ∂‘µ‘√âÕ¬≈–
§”𑬓¡
®”π«πºŸâªÉ«¬∑’Ëπ”¡“ª√–‡¡‘π
À¡“¬∂÷ß ºŸâªÉ«¬∑’Ë¢÷Èπ∑–‡∫’¬π√—°…“„À¡à∑—ÈßÀ¡¥
(À—°≈∫) ºŸâªÉ«¬‚Õπ¬â“¬‰ª∑’ËÕ◊Ëπ
®”π«πºŸâªÉ«¬∑’Ë cure
À¡“¬∂÷ß ºŸâªÉ«¬ new pulmonary M+ √—°…“
§√∫¥â«¬√–∫∫¬“ CAT 1 (2HRZE/4HR) ·≈–º≈
µ√«®‡ ¡À– ‡ªìπ≈∫ 2 §√—Èß (two occasions) ·≈–
‡ªìπ≈∫Àπ÷Ëߧ√—È߇¡◊ËÕ ‘Èπ ÿ¥°“√√—°…“
(º≈‡ ¡À–‡¡◊ËÕ ‘Èπ ÿ¥°“√√—°…“ §◊Õ º≈‡ ¡À–
‡¡◊ËÕ‡√‘Ë¡µâπ √–À«à“ß À√◊Õ ‘Èπ ÿ¥¢Õ߇¥◊Õπ ÿ¥∑⓬¢Õß
°“√√—°…“)
®”π«πºŸâªÉ«¬∑’Ë complete treatment À¡“¬∂÷ß ºŸâªÉ«¬ new pulmonary M+ √—°…“§√∫ º≈
µ√«®‡ ¡À–‡¡◊ËÕ ‘Èπ ÿ¥ initial phase ‡ªìπ≈∫ ·µà„π con- tinuous phase ‰¡à¡’º≈µ√«®‡ ¡À–À√◊Õ¡’‡æ’¬ß 1 §√—Èß
∑’ˇªìπ≈∫ ‚¥¬‡©æ“–Õ¬à“߬‘Ë߉¡à¡’º≈µ√«®‡ ¡À–‡¡◊ËÕ ‘Èπ
µ“√“ß∑’Ë 1 ≈—°…≥–∑—Ë«‰ª¢Õß ºŸâªÉ«¬«—≥‚√§ªÕ¥∑’Ë¢÷Èπ∑–‡∫’¬π
„À¡à‡ ¡À–∫«° ªï 2547-2549 (n = 341 √“¬)
ªï 2547-2549
¢âÕ¡Ÿ≈
®”π«π √âÕ¬≈–
‡æ»
™“¬ 243 71.3
˭ԧ 98 28.7
Õ“¬ÿ (ªï)
0-19 11 3.2
20-29 53 15.5
30-39 59 17.3
40-49 62 18.2
50-59 56 16.4
60 -69 62 18.2
70-79 30 8.8
≥ 80 8 2.4
min=13, max=85, mean=47.4, SD=17.1 Õ“™’æ
√—∫®â“ß 179 52.5
∑”π“ ∑”‰√à ∑” «π 62 18.2
Õ“»—¬Õ¬Ÿà°—∫∫ÿµ√ 35 10.3
π—°‡√’¬π π—°»÷°…“ 21 6.2
§â“¢“¬ 18 5.3
π—°∫«™ 13 3.7
¢â“√“™°“√ ¢â“√“™°“√∫”π“≠ 9 2.6
Õ◊ËπÊ 4 1.2
Journal of Health Science 2008 Vol. 17 No. 4
540
ÿ¥°“√√—°…“ À√◊Õ ºŸâªÉ«¬ new M- √—°…“§√∫ ºŸâªÉ«¬
«—≥‚√§ªÕ¥‡ ¡À–≈∫ (new M-) √—°…“§√∫
º≈°“√»÷°…“
ºŸâªÉ«¬«—≥‚√§√“¬„À¡à‡ ¡À–∫«° ®”π«π 341 √“¬
à«π„À≠à‡ªìπ‡æ»™“¬ √âÕ¬≈– 71.3 ™à«ßÕ“¬ÿ 30-60 ªï
√âÕ¬≈– 51.9 ∂—¥¡“‡ªìπ°≈ÿࡺŸâ ŸßÕ“¬ÿ √âÕ¬≈– 26.4 °≈ÿà¡
‡¥Á° 0-19 ªï ¡’√âÕ¬≈– 3.2 Õ“¬ÿπâÕ¬∑’Ë ÿ¥ 13 ªï ¡“°∑’Ë ÿ¥
85 ªï ‡©≈’ˬ 47.4 ªï ¡’Õ“™’æ√—∫®â“ß¡“°∑’Ë ÿ¥ √âÕ¬≈– 52.5
√Õß≈ß¡“Õ“™’懰…µ√°√ √âÕ¬≈– 18.2 ·≈–Õ“»—¬∫ÿµ√
√âÕ¬≈– 10.3 (µ“√“ß∑’Ë 1)
„πªï 2547-2549 ¡’ºŸâªÉ«¬¢÷Èπ∑–‡∫’¬π ®”π«π 858
√“¬ ‡ªìπºŸâªÉ«¬„À¡à¡“°∑’Ë ÿ¥ §◊Õ √âÕ¬≈– 84.6, 82.0 ·≈–
84.3 µ“¡≈”¥—∫ √Õß≈ß¡“‡ªìπ°≈ÿà¡¢“¥¬“¡“°°«à“ 2
‡¥◊Õπ ·≈–°≈ÿࡺŸâªÉ«¬∑’Ë àßµ—«‡¢â“¡“µ“¡≈”¥—∫ ‚¥¬¡’
ºŸâªÉ«¬∑’Ë√—°…“§√∫·≈â«°≈—∫¡“‡ªìπ„À¡à (relapse case) ªïß∫ª√–¡“≥ 2548 ¡“°∑’Ë ÿ¥ 5.3 √Õß≈ß¡“„π ªïß∫ª√–¡“≥ 2547 √âÕ¬≈– 3.0 æ∫«à“‡°◊Õ∫§√÷Ë߉¥â
®“°°“√«‘π‘®©—¬‚¥¬‡ ¡À–∫«°√à«¡°—∫¿“æ∂à“¬√—ß ’ ªÕ¥‡¢â“À√◊Õ‰¡à‡¢â“‰¥â°—∫√Õ¬‚√§«—≥‚√§ √âÕ¬≈– 42.3
√Õß≈ß¡“‰¥â·°à°“√«‘π‘®©—¬®“°¿“æ∂à“¬√—ß ’ªÕ¥‡¢â“‰¥â
°—∫«—≥‚√§·≈–º≈‡ ¡À–‡ªìπ≈∫√âÕ¬≈– 39.0 ¡’®”π«π ºŸâªÉ«¬∑’˵√«®‡ ¡À–æ∫‡™◊ÈÕ ®”π«π 341 √“¬ (µ“√“ß∑’Ë 2)
µ“√“ß∑’Ë 2 °“√«‘π‘®©—¬ºŸâªÉ«¬«—≥‚√§ ∑’Ë¢÷Èπ∑–‡∫’¬π∑’˧≈‘π‘°«—≥‚√§
ªï 2547 ªï 2548 ªï 2549
¢âÕ§«“¡ √«¡
®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈– ®”π«π √âÕ¬≈–
ª√–‡¿∑°“√¢÷Èπ∑–‡∫’¬π
New case 198 84.6 246 82.00 273 84.3 717
Relapse 7 3.0 16 5.33 3 0.9
Failure 1 0.4 3 1.00 7 2.2
Treatment after default 16 6.7 27 9.00 15 4.6
Refer in 12 5.3 8 2.67 10 3.1
Other 0 0.00 0 0.00 16 4.9
°“√«‘π‘®©—¬
√“¬„À¡à‡ ¡À–∫«°·≈–µ√«®‰¥â¿“æ√—ß ’ 114 48.7 116 38.7 128 39.5 (43.37)
∑√«ßÕ° ±
¿“æ√—ß ’∑√«ßÕ°‡¢â“‰¥â°—∫«—≥‚√§ 95 40.6 117 39.0 121 37.3 (39.97)
·≈–µ√«®‡ ¡À–‡ªìπ≈∫
®“°º≈°“√µ√«®™‘Èπ‡π◊ÈÕ 20 8.6 48 16.0 45 13.9
°“√º≈™‘Èπ‡π◊ÈÕ √à«¡°—∫ ¿“æ∂à“¬√—ß ’ 5 2.1 19 6.3 6 1.9
∑√«ßÕ°‡¢â“‰¥â°—∫«—≥‚√§ À√◊Õµ√«®
‡ ¡À–‰¥âº≈∫«°
Õ◊Ëπ Ê 0 0.0 0 0.0 24 7.4
®”π«π°“√µ√«®‡ ¡À– 234 - 300 - 324 - 858
®”π«π°“√æ∫‡™◊ÈÕ 104 30.5 113 33.1 124 36.4 341
„π®”π«πºŸâªÉ«¬‡ ¡À–∫«°√“¬„À¡à 341 √“¬ ¡’
º≈°“√√—°…“À“¬¡“°∑’Ë ÿ¥ √âÕ¬≈– 69.2 √—°…“§√∫
√âÕ¬≈– 7.6 √«¡‡ªì𧫓¡ ”‡√Á®„π°“√√—°…“ ‡∑à“°—∫
√âÕ¬≈– 76.8 √Õß≈ß¡“‡ªìπºŸâªÉ«¬ ∑’ˇ ’¬™’«‘µ √âÕ¬≈– 12.8
¢“¥°“√√—°…“ √âÕ¬≈– 2.4 √—°…“≈⡇À≈« √âÕ¬≈– 5.3 Õ—µ√“‡ ¡À–ª√“»®“°‡™◊ÈÕ‡¡◊ËÕ ‘Èπ ÿ¥°“√√—°…“ (conver- sion rate) √âÕ¬≈– 79.2 ¬—ߵ˔°«à“‡°≥±å¡“µ√∞“π¢Õß WHO(1) (¡“°°«à“√âÕ¬≈– 85) º≈¢â“߇§’¬ß∑’Ëæ∫‰¥â
∫àÕ¬¡“°∑’Ë ÿ¥ §◊Õ µ—∫Õ—°‡ ∫ √âÕ¬≈– 53.8 §≈◊Ëπ‰ â Õ“‡®’¬π
·πàπ∑âÕß √âÕ¬≈– 23.1 æ∫ºŸâªÉ«¬∑’Ë¡’°“√µ‘¥‡™◊ÈÕ‡Õ¥ å
®”π«π 29 √“¬ §‘¥‡ªìπ√âÕ¬≈– 8.5 (µ“√“ß∑’Ë 3)
√–¬–‡«≈“∑’˺ŸâªÉ«¬«—≥‚√§¢“¥°“√√—°…“ √«¡ 8 √“¬
æ∫«à“ ¢“¥°“√√—°…“‡¡◊ËÕ√—°…“‰¥â 2 ‡¥◊Õπ¡“°∑’Ë ÿ¥ 4 √“¬
·≈– 3 ‡¥◊Õπ 2 √“¬ ·≈–¢“¥°“√√—°…“Õ¬à“ß≈–√“¬„π
‡¥◊Õπ∑’Ë 1 ·≈– 4 “‡Àµÿ°“√¢“¥°“√√—°…“ æ∫«à“ºŸâ ªÉ«¬‡ ’¬™’«‘µ‰ª·≈â«®”π«π 2 √“¬ ‰¡àæ∫ºŸâªÉ«¬∑’Ë∫â“π
®”π«π 1 √“¬ ºŸâªÉ«¬™√“ ®”π«π 1 √“¬ ‰ª√—∫°“√
√—°…“‚√ß欓∫“≈Õ◊Ëπ ®”π«π 1 √“¬ ‰ª√—∫°“√√—°…“ µàÕ
∑’Ë»Ÿπ¬å«—≥‚√§ ®”π«π 1 √“¬ (µ“√“ß∑’Ë 4)
§√÷ËßÀπ÷ËߢÕߺŸâ —߇°µ°“√≥å°‘π¬“ ‡ªìπ≠“µ‘¡“°∑’Ë ÿ¥
µ“√“ß∑’Ë 3 º≈°“√√—°…“ºŸâªÉ«¬«—≥‚√§ªÕ¥‡ ¡À–∫«° (n = 341)
º≈°“√√—°…“ ®”π«π (√“¬) √âÕ¬≈–
º≈°“√√—°…“
√—°…“À“¬ 236 69.2
‡ ’¬™’«‘µ 44 12.9
√—°…“§√∫ 26 7.6
≈⡇À≈« 18 5.3
¢“¥°“√√—°…“ 8 2.4
·æ⬓√ÿπ·√ßµâÕßÀ¬ÿ¥¬“ 6 1.8
àßµàÕ 3 0.9
Õ—µ√“‡ ¡À–ª√“»®“°‡™◊ÈÕ‡¡◊ËÕ 270/341 79.2 ‘Èπ ÿ¥√–¬–‡¢â¡¢âπ¡“°°«à“
√âÕ¬≈– 85 (Conversion rate)
º≈¢â“߇§’¬ß®“°¬“µâ“π«—≥‚√§ (n=26 √“¬)
µ—∫Õ—°‡ ∫ 14 53.8
§≈◊Ëπ‰ â Õ“‡®’¬π ·πàπ∑âÕß 6 23.1
º◊Ëπ§—π 2 7.7
ª«¥¢âÕ 4 15.4
ºŸâªÉ«¬‡Õ¥ å 29 8.5
µ“√“ß∑’Ë 4 °“√µ‘¥µ“¡‡¬’ˬ¡∫â“π
“‡Àµÿ∑’Ë¢“¥°“√√—°…“ ®”π«π º≈°“√ªØ‘∫—µ‘
1. ‡ ’¬™’«‘µ‰ª·≈â« 2 ®”Àπà“¬ÕÕ°®“°∑–‡∫’¬π
2. ‰ª√—∫°“√√—°…“∑’Ë ∂“π欓∫“≈Õ◊Ëπ 1 àߪ√–«—µ‘‰ª¬—ß ∂“π欓∫“≈Õ◊Ëπ Ê
3. ºŸâªÉ«¬Õ“¬ÿ¡“°·≈â« 1 „À⧔·π–π”°—∫ ≠“µ‘ ·≈–ºŸâªÉ«¬ À≈—ß®“°π—Èπ °”Àπ¥«—π¡“µ√«®
µ“¡π—¥
4. ‰¡à§àÕ¬¡’‡«≈“·≈–‡ÀÁπ«à“¡“‰¡àµ√ßπ—¥®÷߉¡à¡“ 1 À≈—ß®“°‰¥â√—∫°“√Õ∏‘∫“¬ºŸâªÉ«¬‡¢â“„®¥’·≈–¡“µ√«®µ“¡π—¥
5. ‰¡àæ∫ºŸâªÉ«¬∑’Ë∫â“π¬â“¬ÕÕ°®“°æ◊Èπ∑’Ë 1 Õ∫∂“¡‡æ◊ËÕπ∫â“π „Àâ¢âÕ¡Ÿ≈«à“ ‰¡à∑√“∫«à“ºŸâªÉ«¬¬â“¬‰ªÕ¬Ÿà∑’Ë„¥
6. ‰ª√—∫°“√√—°…“µàÕ∑’Ë»Ÿπ¬å«—≥‚√§ 2 àߪ√–«—µ‘‰ª¬—ß»Ÿπ¬å«—≥‚√§
√«¡ 8
Journal of Health Science 2008 Vol. 17 No. 4
542
ºŸâªÉ«¬∫“ß√“¬∑’ˉ¡à¡’∑’ËÕ¬Ÿà™—¥‡®π ‡√à√àÕπ‰ª∑”ß“π„π∑’Ë µà“ß Ê ‚¥¬‡©æ“–„π°≈ÿࡵ‘¥‡™◊ÈÕ‡Õ¥ å ´÷Ëß®“°°“√
»÷°…“¢Õß π‘Õ√ Õ√‘‚¬∑—¬ ·≈–§≥–(7) æ∫«à“ªí®®—¬∑’Ë¡’
§«“¡ —¡æ—π∏å°—∫°“√¢“¥°“√√—°…“„πºŸâªÉ«¬«—≥‚√§ªÕ¥
æ∫‡™◊ÈÕ√“¬„À¡à §◊Õ Õ“™’æ √“¬‰¥â ·≈–·À≈à߇ߑπ ”À√—∫§à“√—°…“ §à“‡¥‘π∑“ß ºŸâªÉ«¬∫“ß√“¬·µà‡¥‘¡¡’ß“π
∑” ·µàÀ≈—ß®“°ªÉ«¬ ®”‡ªìπµâÕßÀ¬ÿ¥ß“π∫àÕ¬ ∫“ß à«π
∂Ÿ°√—߇°’¬®®“°‡æ◊ËÕπ√à«¡ß“π ·≈– à«πÀπ÷Ë߇ªìπºŸâ ŸßÕ“¬ÿ ºŸâæ‘°“√ ºŸâµ‘¥‡™◊ÈÕ‡Õ¥ å ‰¡à –¥«°¡“√—∫¬“µ“¡°”À𥇫≈“
√“¬‰¥â≈¥≈ß µâÕßÕÕ°®“°ß“π √Ÿâ ÷°‡ªìπ¿“√–·≈–∑âÕ„®
®π„π∑’Ë ÿ¥®÷߉¡à¡“æ∫·æ∑¬å ·≈–¢“¥°“√√—°…“(8,9) Õ¬à“߉√°Áµ“¡°“√»÷°…“§√—Èßπ’Èæ∫«à“ºŸâªÉ«¬∑—ÈßÀ¡¥ 341 √“¬
¡’°“√µ√«®‡≈◊Õ¥‡æ◊ËÕ§âπÀ“‡™◊ÈÕ‡Õ¥ å‡æ’¬ß 134 √“¬ ·≈–
º≈‡≈◊Õ¥æ∫«à“¡’‡≈◊Õ¥∫«° ®”π«π 29 √“¬ √âÕ¬≈– 8.5 (µ“√“ß∑’Ë 4) Õ“®®–¡’ºŸâªÉ«¬∑’˵‘¥‡™◊ÈÕ‡Õ¥ åÕ¬ŸàÕ’°„π°≈ÿà¡
ºŸâªÉ«¬∑’ˉ¡à‰¥âµ√«®‡≈◊Õ¥ ·≈– ‘Ëß∑’˧«√æ—≤π“µàÕ‰ª §◊Õ
§«“¡√à«¡¡◊Õ√–À«à“ߧ≈‘π‘°«—≥‚√§·≈–§≈‘π‘°‡Õ¥ å ‚¥¬
‡©æ“–§≈‘π‘°«—≥‚√§µâÕß¡’°“√§âπÀ“√“¬ªÉ«¬„Àâ¡“°¢÷Èπ
´÷Ëß®“°°“√»÷°…“∑’˺à“π¡“ æ∫«à“ºŸâªÉ«¬«—≥‚√§∑’˵‘¥‡™◊ÈÕ
‡Õ¥ å¡’º≈°“√√—°…“∑’ˉ¡à¥’ ¡’Õ—µ√“µ“¬ Ÿß (40.8%) ¡’
Õ—µ√“°“√√—°…“À“¬µË”¡“° (40.8%)(6) ·≈–æ∫«à“ºŸâªÉ«¬
∑’Ë ‰¥â√—∫°“√‡®“–‡≈◊Õ¥·≈â«¡’º≈‡≈◊Õ¥‡ªìπ≈∫ ¡’Õ—µ√“
ª√– ∫º≈ ”‡√Á®„π°“√√—°…“¡“°°«à“ºŸâ∑’Ë¡’‡≈◊Õ¥∫«°
ª√–¡“≥ 2.8(10) ·≈–„π¢≥–π’ȧ≈‘π‘°«—≥‚√§‰¥â¡’‡ªÑ“À¡“¬
„π°“√µ√«®‡≈◊Õ¥À“‡™◊ÈÕ HIV „πºŸâªÉ«¬√“¬„À¡à∑ÿ°√“¬
‡æ◊ËÕ§âπÀ“ºŸâªÉ«¬«—≥‚√§∑’ˇªìπ‚√§‡Õ¥ å√à«¡ ‚¥¬°àÕπ
°“√‡®“–‡≈◊Õ¥®–¡’°“√„À⧔ª√÷°…“„πºŸâªÉ«¬∑ÿ°√“¬
æ√âÕ¡„À⺟âªÉ«¬À√◊Õ≠“µ‘ ≈ß√“¬™◊ËÕ‡ªìπÀ≈—°∞“π‰«â¥â«¬
®–‡ªìπ ‘Ëß∑’˙૬‡æ‘Ë¡º≈ ”‡√Á®„π°“√√—°…“«—≥‚√§„πºŸâªÉ«¬
∑’Ë¡’ˇ™◊ÈÕ‡Õ¥ 剥â‡æ‘Ë¡¢÷Èπ
º≈°“√√—°…“ºŸâªÉ«¬«—≥‚√§ªÕ¥‡ ¡À–æ∫‡™◊ÈÕ ·≈–
‰¡à‡§¬‰¥â√—∫°“√√—°…“¡“°àÕπ æ∫«à“¡’Õ—µ√“§«“¡ ”‡√Á®
„π°“√√—°…“ √âÕ¬≈– 69.2 ¬—ߵ˔°«à“‡ªÑ“À¡“¬¢Õß Õߧ尓√Õπ“¡—¬‚≈°Õ¬à“ß¡“°∑’Ë°”À𥉫â(1) ‡∑à“°—∫
√âÕ¬≈– 85 ·≈–º≈°“√»÷°…“π’È¡’°“√§âπÀ“√“¬ªÉ«¬‰¥â
µ“√“ß∑’Ë 5 ºŸâ —߇°µ°“√≥å°‘π¬“ ·≈– “‡Àµÿ°“√‡ ’¬™’«‘µ ªï 2547-2549
®”π«π √âÕ¬≈–
ºŸâ —߇°µ°“√≥å
1. ≠“µ‘ 172 50.5
2. µπ‡Õß 143 41.9
3. ‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢ 26 7.6
√«¡ 341 100.0
“‡Àµÿ°“√‡ ’¬™’«‘µ
°“√‡®Á∫ªÉ«¬ 18 39.1
‡ ’¬™’«‘µ®“°™√“¿“æ 16 17.4
°“√µ‘¥‡™◊ÈÕ‡Õ¥ å 15 32.6
Õ◊Ëπ Ê 5 10.9
√«¡ 46 100.0
√âÕ¬≈– 50.4 √Õß≈ß¡“§◊Õµπ‡Õß ®–‡ÀÁπ‰¥â«à“ºŸâ —߇°µ-
°“√≥å∑’ˇªìπ‡®â“Àπâ“∑’Ë¡’ —¥ à«π∑’ËπâÕ¬¡“°‡æ’¬ß √âÕ¬≈– 7.6 “‡Àµÿ°“√‡ ’¬™’«‘µ¢ÕߺŸâªÉ«¬«—≥‚√§ à«π„À≠à‡ ’¬™’«‘µ
®“°°“√‡®Á∫ªÉ«¬¡“°∑’Ë ÿ¥ √âÕ¬≈– 39.1 √Õß≈ß¡“§◊Õ
°“√‡ ’¬™’«‘µ®“°°“√µ‘¥‡™◊ÈÕ‡Õ¥ å √âÕ¬≈– 32.6 (µ“√“ß
∑’Ë 5)
«‘®“√≥å
ºŸâªÉ«¬«—≥‚√§√“¬„À¡à∑’ˉ¡à‡§¬√—°…“¡“°àÕπ √âÕ¬≈–
83.6 √Õß≈ß¡“‡ªìπºŸâªÉ«¬∑’Ë°≈—∫¡“‡ªìπ´È” √âÕ¬≈– 3.0 °“√
«‘π‘®©—¬‚√§ à«π„À≠à„™â«‘∏’°“√‡æ“–‡™◊ÈÕ®“°‡ ¡À–√à«¡
°—∫¿“æ∂à“¬√—ß ’∑√«ßÕ°(4,5) √âÕ¬≈– 39.7 ‡ªìπºŸâªÉ«¬
‡ ¡À–æ∫‡™◊ÈÕ‰¡à‡§¬‰¥â√—∫°“√√—°…“¡“°àÕπ ®”π«π 341
√“¬ §‘¥‡ªìπ√âÕ¬≈– 39.7 (µ“√“ß∑’Ë 2) ´÷Ëß Õ¥§≈âÕß°—∫
º≈°“√»÷°…“∑’˺à“π¡“(6) ´÷Ëß°“√»÷°…“∑’ËÕ◊Ëπæ∫«à“Õ“¬ÿ¢Õß ºŸâªÉ«¬¡—°Õ¬Ÿà„π™à«ß‡°‘π 50 ªï ”À√—∫Õ“™’æ æ∫«à“ à«π
„À≠à¡’Õ“™’æ√—∫®â“ß¡“°∑’Ë ÿ¥ √âÕ¬≈– 52.5 √Õß≈ß¡“
‡ªìπºŸâªÉ«¬∑’Ë¡’Õ“™’懰…µ√°√√¡ √âÕ¬≈– 18.2 °“√
»÷°…“∑’˺à“π¡“ à«π„À≠ຟâªÉ«¬«—≥‚√§¡’Õ“™’æ√—∫®â“ß ¡’
¡“°°«à“ √âÕ¬≈– 70 ‡¡◊ËÕ‡∑’¬∫°—∫®”π«πª√–™“°√„π
‡¢µæ◊Èπ∑’Ë√—∫º‘¥™Õ∫ ·µàæ∫«à“¡’Õ—µ√“º≈ ”‡√Á®„π°“√
√—°…“πâÕ¬¡“° ´÷ËßÕ“®¡’·π«‚πâ¡∑’Ë∑”„À⇰‘¥ºŸâªÉ«¬
«— ≥ ‚ √ § ¥◊È Õ ¬ “ ¡ “ ° ¢÷È π „ π Õ π “ § µ(11) ‡ªìπ ‘Ëß∑’˧«√
µ√–Àπ—°Õ¬à“߬‘Ëß ”À√—∫ºŸâªØ‘∫—µ‘ß“π§«∫§ÿ¡ªÑÕß°—π
«—≥‚√§
”À√—∫Õ—µ√“°“√‡ª≈’Ë¬π‡ ¡À–®“°∫«°‡ªìπ≈∫
(sputum conversion rate) ‡¡◊ËÕ ‘Èπ ÿ¥√–¬–‡¢â¡¢âπ
√âÕ¬≈– 79.2 ´÷Ëß¡’§à“µË”°«à“‡°≥±å¡“µ√∞“πÕߧ尓√
Õπ“¡—¬‚≈°1 Õ“®‡π◊ËÕß®“°æ∫«à“Õ—µ√“µ“¬¡’§à“ Ÿß¡“°
æ∫ºŸâªÉ«¬∑’ˇ ’¬™’«‘µ ®”π«π 44 √“¬ §‘¥‡ªìπ 12.8 (µ“√“ß
∑’Ë 3) º≈°“√§âπÀ“ “‡Àµÿ°“√µ“¬®“°°“√µ‘¥µ“¡ºŸâªÉ«¬
æ∫«à“ ‡ ’¬™’«‘µ®“°™√“¿“æ °“√‡®Á∫ªÉ«¬ ·≈–‡ ’¬
™’«‘µ®“°°“√µ‘¥‡™◊ÈÕ‡Õ¥ å(10,12) (µ“√“ß∑’Ë 5) πÕ°®“°π’È
¬—ßæ∫«à“ºŸâªÉ«¬®”π«π 18 √“¬ √âÕ¬≈– 5.3 ¡’º≈°“√
√—°…“≈⡇À≈« ´÷Ëß à«π„À≠àæ∫«à“ºŸâªÉ«¬‡°‘¥º≈¢â“߇§’¬ß
®“°°“√°‘𬓫—≥‚√§ ·≈–Õ“°“√∑âÕ·∑⮓°º≈¢â“߇§’¬ß
∑”„ÀâµâÕ߇ª≈’Ë¬π Ÿµ√¬“ ‚¥¬º≈¢â“߇§’¬ß∑’Ëæ∫¡“°§◊Õ µ—∫
Õ—°‡ ∫ √âÕ¬≈– 53.9 (µ“√“ß∑’Ë 3) Õ“°“√¢â“߇§’¬ß¢Õß
¬“«—≥‚√§ àߺ≈µàÕ ¿“殑µ„®·≈–√à“ß°“¬¢ÕߺŸâªÉ«¬
Õ¬à“ß¡“° àߺ≈„À⺟âªÉ«¬‰¡à°≈â“°≈—∫¡“√—∫°“√√—°…“
Õ¬à“ßµàÕ‡π◊ËÕß ∑”„À⢓¥¬“ ‡°‘¥‡™◊ÈÕ¥◊ÈÕ¬“ 𔉪 Ÿà°“√
ª√—∫‡ª≈’Ë¬π Ÿµ√¬“„π∑’Ë ÿ¥ „π°“√»÷°…“§√—Èßπ’È¡’ºŸâªÉ«¬∑’Ë
¢“¥°“√√—°…“ ®”π«π 8 √“¬ §‘¥‡ªìπ√âÕ¬≈– 2.4 (µ“√“ß
∑’Ë 3) ‚¥¬¡’°“√¢“¥¬“‡¡◊ËÕºŸâªÉ«¬√—°…“‰ª·≈â« 2 ‡¥◊Õπ
¡“°∑’Ë ÿ¥ 4/8 (µ“√“ß∑’Ë 4) „°≈⇧’¬ß°—∫°“√»÷°…“¢Õß
°‘µµ‘æ—π∏å ‡Õ’Ë¬¡√Õ¥∑’Ëæ∫«à“ºŸâªÉ«¬«—≥‚√§¡—°¢“¥¬“‡¡◊ËÕ
√—∫°“√√—°…“‰ª·≈â« 2-3 ‡¥◊Õπ (™à«ß 3 ‡¥◊Õπ·√°) ¡“°
∑’Ë ÿ¥(13) ´÷Ë߇ªìπ√–¬–∑’˺ŸâªÉ«¬µâÕß∑“𬓪√‘¡“≥¡“° ‡°‘¥
º≈¢â“߇§’¬ß¡“° ·≈–æ∫«à“ºŸâªÉ«¬∑’ˉ¡à¡’Õ“°“√¢Õß‚√§
À√◊Õ¡’Õ“°“√· ¥ß¢Õß‚√§πâÕ¬¡—°®–‰¡à„À⧫“¡√à«¡¡◊Õ
„π°“√√—°…“¡“°°«à“ºŸâ∑’Ë¡’Õ“°“√· ¥ß¢Õß‚√§Õ¬à“ß
™—¥‡®π(14) ¥—ßπ—Èπ°“√‡æ‘Ë¡§«“¡‡¢â¡¢âπ„π°“√„Àâ ÿ¢
»÷°…“„π§≈‘π‘° °“√µ‘¥µ“¡ºŸâªÉ«¬„π√–¬–‡¢â¡¢âπ¡’§«“¡
”§—≠¡“°
„π à«πºŸâ°”°—∫°“√°‘π¬“¢ÕߺŸâªÉ«¬«—≥‚√§„π°“√
»÷°…“π’È æ∫«à“ª√–¡“≥§√÷ËßÀπ÷ËߢÕߺŸâ —߇°µ°“√≥å√—∫
ª√–∑“𬓠(DOTS) §◊Õ ≠“µ‘¢ÕߺŸâªÉ«¬‡Õß ·≈–Õ’°
‡°◊Õ∫§√÷ËßÀπ÷ËߢÕߺŸâªÉ«¬‰¡à¡’ºŸâ —߇°µ°“√≥å (µ“√“ß∑’Ë 5)
´÷Ë߇¡◊ËÕ»÷°…“º≈°“√»÷°…“∑’˺à“π¡“(15) æ∫«à“ ºŸâ¥Ÿ·≈
°”°—∫°“√√—°…“«—≥‚√§ à«π„À≠à‡ªìπ ¡“™‘°§√Õ∫-
§√—«(13,15) àߺ≈„À⺟âªÉ«¬¡’Õ—µ√“°“√¢“¥¬“§àÕπ¢â“ß Ÿß
∑”„À⺟âªÉ«¬°‘𬓉¡à§√∫¢π“¥ ∫“ß∑’‡≈◊Õ°°‘π‡©æ“–
∫“ߢπ“π ∫ÿ§§≈∑’Ë∑”Àπâ“∑’Ë„Àâ DOTS §«√‡≈◊Õ°≠“µ‘
‡ªìπÕ—π¥—∫∑⓬ ÿ¥ ·≈–§«√‡≈◊Õ°‡®â“Àπâ“∑’ËÀ√◊Õ∫ÿ§≈“°√
ª√–®” ∂“π’Õπ“¡—¬ ‚√ß欓∫“≈ À√◊Õ Õ“ “ ¡—§√ ºŸâπ”
™ÿ¡™π ‡™àπ Õ“ “ ¡—§√ “∏“√≥ ÿ¢ §√Ÿ æ√– ß¶å ‡ªìπ Õ—π¥—∫·√° ·µà∂Ⓣ¡à “¡“√∂‡≈◊Õ°‰¥â 欓∫“≈ª√–®”
§≈‘π‘°§«√„À⧫“¡√Ÿâ Õ∏‘∫“¬„Àâ≠“µ‘‡¢â“„®∂÷ßÀ≈—°°“√
·≈–«‘∏’°“√ªØ‘∫—µ‘ ·≈–¡’°“√µ‘¥µ“¡‡¬’ˬ¡Õ¬à“ß ¡Ë”‡ ¡Õ
®“°‡®â“Àπâ“∑’Ë ∂“π’Õπ“¡—¬ ‚¥¬°“√ª√– “πß“πºà“π ß“π‡«™°√√¡ —ߧ¡ ‚¥¬‡©æ“–„π™à«ß√–¬–‡¢â¡¢âπ(7,16,17)
„πªí®®ÿ∫—πæ∫«à“°“√¥”‡π‘πß“π„π§≈‘π‘°«—≥‚√§ ¡’
°“√¥”‡π‘πß“π‡æ’¬ß —ª¥“Àå≈– 1 «—𠇫≈“ 08.30 π. - 12.00 π. °“√¡’‡«≈“πâÕ¬ àߺ≈„Àâ√–¬–‡«≈“„π°“√„Àâ
¢âÕ¡Ÿ≈ºŸâªÉ«¬«—≥‚√§·≈–≠“µ‘¡’®”°—¥¡“° ¥—ßπ—Èπ°“√
»÷°…“√–∫∫°“√‡æ‘Ë¡§«“¡‡¢â¡¢âπ„π°“√„Àâ DOTS ·°àºŸâ- ªÉ«¬«—≥‚√§§«√¡’°“√«‘‡§√“–Àå «‘∏’°“√‡æ‘Ë¡°“√¡’ à«π
√à«¡„π°“√∑”Àπâ“∑’Ë¢ÕߺŸâ∑’ˇ°’ˬ«¢âÕß°—∫°“√„Àâ DOTS
‚¥¬‡®â“Àπâ“∑’Ë·≈–ºŸâπ”™ÿ¡™π Õ¬à“߇ªìπ√–∫∫µàÕ‰ª 1. §«√
‡æ‘Ë¡®”π«π‡®â“Àπâ“∑’˪√–®”§≈‘π‘°„Àâ¡“°¢÷Èπ À√◊Õ‡æ‘Ë¡
™àÕß∑“ß„π°“√ª√– “πß“π°—∫‡®â“Àπâ“∑’˧≈‘π‘°«—≥‚√§
2. ®—¥∑” TB counseling call ‡æ◊ËÕ„À⺟âªÉ«¬ ·≈–≠“µ‘
¡’·À≈à߇¢â“∂÷ߢâÕ¡Ÿ≈ ‚¥¬‡©æ“–‡¡◊ËÕ‡°‘¥º≈¢â“߇§’¬ß®“°
¬“√—°…“«—≥‚√§ ®–‰¥â√—∫§”·π–π”„π∑—π∑’ ‡æ◊ËÕ„À⇰‘¥
º≈°√–∑∫µàÕºŸâªÉ«¬„ÀâπâÕ¬∑’Ë ÿ¥ 3. ‡æ‘Ë¡§«“¡‡¢â¡¢âπ„π
°“√µ‘¥µ“¡ºŸâªÉ«¬ ‡™à𠵑¥µ“¡¥â«¬°“√„™â‚∑√»—æ∑å °“√
„™â«‘∑¬ÿ ◊ËÕ “√ ‡¢’¬π®¥À¡“¬∂÷ß∑’ËÕ¬Ÿà¢ÕߺŸâªÉ«¬ ‚¥¬°“√
ª√– “πß“π°—∫Àπ૬ߓπ∑’ˇ°’ˬ«¢âÕß
Journal of Health Science 2008 Vol. 17 No. 4
544
¢âÕ‡ πÕ·π–
1. §«√‡πâπ„Àâ™ÿ¡™π¡’ à«π√à«¡„π°“√§«∫§ÿ¡ °”°—∫
¥Ÿ·≈ ª√– “πß“π°—∫‡®â“Àπâ“∑’Ë “∏“√≥ ÿ¢Õ¬à“ß„°≈♑¥
‡¡◊ËÕºŸâªÉ«¬°≈—∫‡¢â“‰ªÕ¬Ÿà„π™ÿ¡™π ¡’°“√Õ∫√¡ºŸâπ”™ÿ¡™π
„Àâ¡’§«“¡√Ÿâ§«“¡‡¢â“„®„π¥Ÿ·≈ºŸâªÉ«¬ µ‘¥µ—Èß√–∫∫°“√
ª√– “πß“π®“°™ÿ¡™π ŸàÀπ૬ߓπ¢Õß√—∞ µ—Èß·µà ∂“π’
Õπ“¡—¬‚√ß欓∫“≈ Õߧå°√ª°§√Õß à«π∑âÕß∂‘Ëπ œ≈œ 2. §«√‡πâπ∂÷ß°√–∫«π°“√„Àâ ÿ¢»÷°…“·°àºŸâªÉ«¬
·≈–≠“µ‘‚¥¬‡©æ“–ºŸâªÉ«¬∑’Ë¢÷Èπ∑–‡∫’¬π„À¡à‡æ◊ËÕ„À⺟âªÉ«¬
À“¬®“°‚√§·≈–°≈—∫§◊π Ÿà ¿“懥‘¡‚¥¬‡√Á«∑’Ë ÿ¥ ∑—Èßπ’È
§«√‡πâπ„π‡√◊ËÕߢÕß°“√°‘𬓵àÕ‡π◊ËÕßÕ¬à“ß ¡Ë”‡ ¡Õ
·ºπ°“√√—°…“¢Õß·æ∑¬å °“√µ‘¥µàÕ·æ√à‡™◊ÈÕ¢Õß«—≥‚√§
πÕ°®“°π—Èπ§«√„Àâ ÿ¢»÷°…“´È”‡¡◊ËÕºŸâªÉ«¬¡“√—∫¬“„π
‡¥◊ÕπÀ≈—ß ®–™à«¬„À⺟âªÉ«¬√—∫¬“‡æ‘Ë¡¢÷Èπ
3. §«√»÷°…“À“ “‡Àµÿ¢ÕߺŸâªÉ«¬∑’Ë¢“¥°“√√—°…“
‚¥¬‡©æ“–„πºŸâªÉ«¬À≈—ß°“√√—°…“‰¥â‡æ’¬ß 2-3 ‡¥◊Õπ ‡æ◊ËÕ π”¡“«“ß·ºπ·°âªí≠À“„π°“√¥”‡π‘πß“πµàÕ‰ª
4. § « √ ¡’ ° “ √ µ‘ ¥ µ “ ¡ ‡ ¬’Ë ¬ ¡ ∫â “ π „ π ºŸâ ªÉ « ¬ ∑’Ë ¢÷È π
∑–‡∫’¬π„À¡à„π·µà≈–‡¥◊Õπ ‡æ◊ËÕ∑√“∫∂÷ß ¿“æ∑“ß
‡»√…∞°‘® —ߧ¡ ·≈–§«“¡‡ªìπÕ¬Ÿà §«“¡ —¡æ—π∏å„π
§√Õ∫§√—«µ≈Õ¥®πªí®®—¬·«¥≈âÕ¡µà“ß Ê Õ’°∑—È߇ªìπ°“√
√â“ß —¡æ—π∏å¿“æ∑’Ë¥’√–À«à“ߺŸâªÉ«¬·≈–‡®â“Àπâ“∑’Ë ‡ªìπ°“√
‡ √‘¡ √â“ß°”≈—ß„®„ÀⷰຟâªÉ«¬·≈–≠“µ‘„Àâ‡ÀÁ𧫓¡
”§—≠·≈–„À⧫“¡√à«¡¡◊Õ¡“°¢÷Èπ
5. §«√‡æ‘Ë¡®”π«π«—π„π°“√„Àâ∫√‘°“√„π§≈‘π‘°
«—≥‚√§„Àâ¡“°¢÷Èπ À√◊Õ ®—¥„Àâ¡’ DOTS corner „π‚√ß- 欓∫“≈ ‚¥¬¡’欓∫“≈«‘™“™’æ ‡µ√’¬¡æ√âÕ¡‡æ◊ËÕ¥Ÿ·≈
ºŸâªÉ«¬«—≥‚√§∑ÿ°«—π ‚¥¬‡©æ“–‡¡◊ËÕ‡°‘¥º≈¢â“߇§’¬ß®“°
°“√„™â¬“ À√◊Õ¡’ “¬¥à«π‡æ◊ËÕ„À⧔ª√÷°…“
°‘µµ‘°√√¡ª√–°“»
¢Õ¢Õ∫§ÿ≥ 𓬷æ∑¬å°”™—¬ √—ß ‘¡—πµå‰æ∫Ÿ≈¬å ºŸâ- Õ”π«¬°“√‚√ß欓∫“≈°”·æ߇æ™√ ∑’ËÕπÿ≠“µ„Àâ
∑”°“√»÷°…“ 欓∫“≈ª√–®”§≈‘π‘°«—≥‚√§∑ÿ°∑à“𠇮â“-
‡Õ° “√Õâ“ßÕ‘ß
1. World Health Organization. Global tuberculosis con- trol-WHO report 2001. Geneva. Switzerland WHO/
CDS/TB/2001; 278.
2. ”π—°√–∫“¥«‘∑¬“ °√¡§«∫§ÿ¡‚√§. ¢âÕ¡Ÿ≈°“√‡ΩÑ“√–«—ß‚√§
2546-2549. [online] 2550. [ ◊∫§âπ‡¡◊ËÕ 1 ‡¡…“¬π 2551] :
·À≈àߢâÕ¡Ÿ≈; URL : http\\203.157.15.4 (03/04/2008) 3. ™—¬‡«™ πÿ™ª√–¬Ÿ√. °“√√—°…“«—≥‚√§ªÕ¥„πªí®®ÿ∫—π. „π : ‡«™
ªØ‘∫—µ‘„π§≈‘π‘°‡©æ“–‚√§. «‘∑¬“ »√’¥“¡“, ∫√√≥“∏‘°“√. æ‘¡æå
§√—Èß∑’Ë 2. °√ÿ߇∑æ¡À“π§√ : ‚§√ß°“√µ”√“®ÿÓՓ¬ÿ√»“ µ√å;
2548. Àπâ“ 232-41.
4. Bellin E, Fletcher D, Safyer S. Abnormal chest x-rays in intravenous drug users: implications for tuberculo- sis screening programs. Am J Public Health 1993;
5:698-700.
5. ∫—≠≠—µ‘ ª√‘™≠“ππ∑å. ·π«∑“ß°“√«‘π‘®©—¬·≈–√—°…“«—≥‚√§
ªÕ¥. „π : π≈‘π’ Õ—»«¿§’, ÿ√¿’ ‡∑’¬π°√‘¡, »»‘∏√ ≈‘¢‘µπÿ°Ÿ≈, Õ—…Ø“ «‘¿“°ÿ≈, ∫√√≥“∏‘°“√: ª√– ∫°“√≥å¥â“π‚√§µ‘¥‡™◊ÈÕ„π ª√–‡∑»‰∑¬. æ‘¡æå§√—Èß∑’Ë 2. °√ÿ߇∑æ¡À“π§√ : ¡“§¡‚√§
µ‘¥‡™◊ÈÕ·Ààߪ√–‡∑»‰∑¬; 2542. Àπâ“ 276-81.
6. ™—¬»‘≈ªá ¥”¥â«ß. º≈°“√¥”‡π‘πß“π§«∫§ÿ¡«—≥‚√§„π‚√ß- 欓∫“≈ µŸ≈ (µÿ≈“§¡ 2542-°—𬓬π 2545). «“√ “√
«—≥‚√§∑√«ßÕ°·≈–‡«™∫”∫—¥«‘°ƒµ 2547; 25 (4):199-206.
7. π‘Õ√ Õ√‘‚¬∑—¬, ∫ÿ≠‡™‘¥ °≈—¥æà«ß, «“√’ ∏π– ¡∫Ÿ√≥å, ÿ¥„®
§ß “¡ ’. °“√¢“¥°“√√—°…“¢ÕߺŸâªÉ«¬«—≥‚√§ªÕ¥‡ ¡À–æ∫
‡™◊ÈÕ√“¬„À¡à. «“√ “√«—≥‚√§∑√«ßÕ°·≈–‡«™∫”∫—¥«‘°ƒµ 2546; 24 (1):167-73.
8. Õÿ∑—¬«√√≥ °“≥®πæ—ߧ–. ‡ª√’¬∫‡∑’¬∫ª√– ‘∑∏‘º≈¢Õß DOTS
‚¥¬‡®â“Àπâ“∑’Ë ·≈– DOTS ‚¥¬≠“µ‘„π°“√√—°…“ºŸâªÉ«¬«—≥‚√§
”π—°Õπ“¡—¬ °√ÿ߇∑æ¡À“π§√ 2543. «“√ “√«—≥‚√§·≈–
‚√§∑√«ßÕ° 2546; 24 (1):255-62.
9. McKenzie A, Kashef I, Jon DT, Valdis E K, Lois AD, Beverly M, et al. Transmission network analysis to complement routine tuberculosis contact investigations.
American Journal of Public Health 2006; 97(3):470- 7.
10. ‡®√‘≠ ™Ÿ‚™µ‘∂“«√. «—≥‚√§„πºŸâ„À≠à. „π: æ√√≥∑‘æ¬å ©“¬“°ÿ≈,
™‘…≥ÿ æ—π∏ÿ凮√‘≠, ™ÿ…≥“ «π°√–µà“¬, ÿ√¿’ ‡∑’¬π°√‘¡, ¬ÿæ‘π
»ÿæÿ∑∏¡ß§≈, »»‘∏√ ≈‘¢‘µπÿ°Ÿ≈, ∫√√≥“∏‘°“√. µ”√“‚√§µ‘¥‡™◊ÈÕ.
°√ÿ߇∑æ¡À“π§√: ¡“§¡‚√§µ‘¥‡™◊ÈÕ·Ààߪ√–‡∑»‰∑¬; 2548.
Àπâ“ 683-715.
11. π‘∏‘æ—≤πå ‡®’¬√°ÿ≈. ¢âÕ‡ πÕ«—≥‚√§¥◊ÈÕ¬“À≈“¬™π‘¥. «“√ “√
Àπâ“∑’Ëß“π»Ÿπ¬å¢âÕ¡Ÿ≈ “√ π‡∑» ∑’Ë¡’ à«π‡°’ˬ«¢âÕß„π
°“√»÷°…“¢âÕ¡Ÿ≈§√—Èßπ’È
«—≥‚√§∑√«ßÕ°·≈–‡«™∫”∫—¥«‘°ƒµ 2550; 28 (2):7-11.
12. «‘®—°…≥“ Àÿµ“ππ∑å, ƒ∑—¬«√√≥å ∫ÿ≠‡ªìπ‡¥™, »ÿ¿√—µπå ∫ÿ≠π“§.
°“√»÷°…“√Ÿª·∫∫°“√¥Ÿ·≈ºŸâªÉ«¬«—≥‚√§·≈–«—≥‚√§µ‘¥‡™◊ÈÕ‡Õ™
‰Õ«’·∫∫Õߧå√«¡‚¥¬™ÿ¡™π¡’ à«π√à«¡ (°√≥’»÷°…“Õ”‡¿Õ‡¡◊Õß
·≈–Õ”‡¿Õ∏—≠∫ÿ√’ ®—ßÀ«—¥ª∑ÿ¡∏“π’). «“√ “√«—≥‚√§∑√«ßÕ°
·≈–‡«™∫”∫—¥«‘°ƒµ 2549; 27 (4):327-42.
13. °‘µµ‘æ—∑∏å ‡Õ’Ë¬¡√Õ¥, ª√“≥’ Õ⓬®ÿâ¡. °“√§«∫§ÿ¡«—≥‚√§µ“¡
·π«∑“ß°“√√—°…“«—≥‚√§·∫∫¡’æ’ˇ≈’È¬ß (DOTS) ®—ßÀ«—¥µ“°
ªïß∫ª√–¡“≥ 2544-2546. «“√ “√«—≥‚√§∑√«ßÕ°·≈–‡«™
∫”∫—¥«‘°ƒµ 2547; 25 (4):194-8.
14. ∏’√«—≤πå «≈—¬‡ ∂’¬√, »√’¡ß§≈ ª√–¬Ÿ√¬«ß. ¿“æ∑“ß —ߧ¡
¢ÕߺŸâªÉ«¬«—≥‚√§¥◊ÈÕ¬“À≈“¬¢π“π MDR-TB ¢Õß»Ÿπ¬å
«—≥‚√§‡¢µ 5 π§√√“™ ’¡“ æ.». 2547. «“√ “√«—≥‚√§
∑√«ßÕ°·≈–‡«™∫”∫—¥«‘°ƒµ 2548; 26 (4):251-8.
15. ‚Õ¿“ °“√≥å°«‘πæß»å. °“√‡æ‘Ë¡ª√– ‘∑∏‘¿“æß“π§«∫§ÿ¡
«—≥‚√§¥â«¬«‘∏’√—°…“·∫∫¡’æ’ˇ≈’Ȭ߂¥¬°“√µ‘¥µ“¡ª√–‡¡‘πº≈
‡™‘ß√ÿ°·∫∫„À¡à. «“√ “√«—≥‚√§∑√«ßÕ°·≈–‡«™∫”∫—¥«‘°ƒµ 2548; 26 (3):199-209.
16. ‡°’¬√µ‘°”®√ °ÿ»≈, ™—¬¬» Õÿ‡¥Áπ. °√≥’»÷°…“: °“√»÷°…“°“√
π—∫ πÿπ®“°∫ÿ§≈“°√∑’¡ ÿ¢¿“æ∑’Ë¡’µàÕºŸâªÉ«¬«—≥‚√§ªÕ¥„π
§≈‘π‘°«—≥‚√§ ‚√ß欓∫“≈∑à“»“≈“. «“√ “√«—≥‚√§∑√«ßÕ°
·≈–‡«™∫”∫—¥«‘°ƒµ; 2548; 26 (1):1-9.
17. ÿ¿“æ √Õπ»÷°, ƒ∑—¬«√√≥å ∫ÿ≠‡ªìπ‡¥™, »ÿ¿√—µπå ∫ÿ≠π“§,
«‘®—°…≥“ Àÿµ“ππ∑å. °“√ √â“ߪ√–™“ —ߧ¡‡æ◊ËÕªÑÕß°—π·≈–
·°â‰¢ ªí≠À“«—≥‚√§·≈–‚√§‡Õ¥ å µ”∫≈∫“߇¥◊ËÕ Õ”‡¿Õ‡¡◊Õß
®—ßÀ«—¥ª∑ÿ¡∏“π’ ªï 2547. «“√ “√«—≥‚√§∑√«ßÕ°·≈–‡«™
∫”∫—¥«‘°ƒµ 2548; 26 (4):271-86.
Journal of Health Science 2008 Vol. 17 No. 4
546
Abstract Tuberculosis Control in Kamphaeng Phet Hospital, from October 2004 to September 2006 Rotjana Khontong
Department of Medicine, Kamphaeng Phet Hospital, Kamphaeng Phet Journal of Health Science 2008; 17:537-46.
The World Health Organization restated global targets for tuberculosis control to treat success- fully 85 percent of detected smear-positive TB cases. The objective of this study was to evaluate on case finding and cure rate of pulmonary tuberculosis in Kamphaeng Phet hospital from September 2004 to October 2006.
The study revealed a total number of TB registered patients on 2004-2006 of 858 cases and reported 341 or 39.7 percent positive sputum in TB suspects mostly male 71.3 percent employed 52.5 percent aged from 13 to 85 years. The new cases of pulmonary tuberculosis (New M+) were treated with 2HRZE/4HR. The resulting were success rate 69.2 percent, conversion rate 79.2 per- cent, default rate 2.4 percent, failure rate 5.3 percent and death rate 12.8 percent. Generally, it showed a low cure rate. The retrieval activity was addressed through the telephone, the radio pro- gram, letter and home visit strategies of the public health station. The factors correlation of the default rate increase was related to death, absence and old age. The author suggests that the strategy indicates community participation and service activities should be strengthened among key commu- nity leaders. Health officers and village health volunteers have to supple adequate care and enough medicine to new patients.
Key words: tuberculosis control, pulmonary tuberculosis
