Page 11 - journal-9-2-Full

88 «“√ “√°“√·æ∑¬å·ºπ‰∑¬·≈–°“√·æ∑¬å∑“߇≈◊Õ° ªï∑’Ë 9©∫—∫∑’Ë 2°—𬓬π-∏—𫓧¡ 2554

ªí “«– 14 √“¬ ·∫àß∑“«—π≈– 2 §√—Èß π“π 2 —ª¥“Àå ‡ªìπ‡«≈“ amcinolone acetonide, TA) ·≈–¬“À≈Õ°„πºŸâªÉ«¬ 87 §π

2 ‡¥◊Õπ æ∫«à“·º≈À“¬ 4 √“¬ (28.6%) „π 2 —ª¥“Àå, 4 √“¬ æ∫«à“‡®≈ “√ °—¥„∫∫—«∫°∑—Èß “¡§«“¡‡¢â¡¢âπ·≈–¬“ TA „Àâ
(28.6%) „π 2-4 —ª¥“Àå, 5 √“¬ (35.7%) „π 4-8 —ª¥“Àå º≈„°≈⇧’¬ß°—π„πÕ—μ√“°“√≈¥¢π“¥¢Õß·º≈·≈–„Àâº≈‡√Á«
45
·≈–‰¡àÀ“¬À≈—ß„™â¬“ 2 ‡¥◊Õπ 1 √“¬ (7.1%) ´÷Ë߇°‘¥®“°º≈°¥∑—∫ °«à“¬“À≈Õ°
39
·≈–‰¡àæ∫Õ“°“√·∑√°´âÕπÕ◊Ëπ Ê 2.4 ƒ∑∏‘Ï√—°…“Õ“°“√¢Õß‚√§ Chronic venous in-
√“¬ß“π°“√„™â§√’¡√—°…“·º≈„π§π‰¢â 22 √“¬ sufficiency
´÷Ëß¡’¢π“¥·º≈°«â“ß 1-12 ‡´π쑇¡μ√ ≈÷° 0.5-3.7 ‡´π쑇¡μ√ Chronic venous insufficiency ‡ªìπ‚√§∑’Ë

‚¥¬ —߇°μº≈„π 1, 2 ·≈– 3 —ª¥“Àå æ∫«à“º≈°“√√—°…“„π ‡°‘¥®“°§«“¡º‘¥ª√°μ‘¢Õß√–∫∫°“√‰À≈‡«’¬π‚≈À‘μ„πÀ≈Õ¥
—ª¥“Àå∑’Ë 1 ¢π“¥·º≈≈¥≈ß 24% —ª¥“Àå∑’Ë 2 ¢π“¥·º≈≈¥ ‡≈◊Õ¥¥” ∑”„À⧫“¡¥—π‚≈À‘μ„πÀ≈Õ¥‡≈◊Õ¥¥”∑’Ë¢“ Ÿß (venous

≈ß 37% ·≈– —ª¥“Àå∑’Ë 3 ¢π“¥·º≈≈¥≈ß 47% ‚¥¬§«“¡≈÷° hypertension) “‡Àμÿ‡°‘¥®“°¡’°“√Õÿ¥μ—π¢ÕßÀ≈Õ¥‡≈◊Õ¥¥”
¢Õß·º≈π—Èπ≈¥≈߉¥â‡√Á«°«à“§«“¡°«â“ß·≈–¬“« πÕ°®“°π’È„π À√◊Õ≈‘ÈπÀ≈Õ¥‡≈◊Õ¥¥”∑”ß“πº‘¥ª°μ‘ À√◊Õ∑—Èß 2 Õ¬à“ß√à«¡°—π
—ª¥“Àå∑’Ë 3 §π‰¢â 17 √“¬ ¡’·º≈∑’ËÀ“¬ π‘∑ à«π 5 √“¬ ¡’‡ âπ‡≈◊Õ¥¥”¢Õ¥∑’Ë¢“ ¡’Õ“°“√∫«¡¢Õߢ“ ¢âÕ‡∑â“∫«¡ √Ÿâ ÷°
40
¢π“¥·º≈≈¥≈ß·μà‰¡àÀ“¬¥’ πÕ°®“°π—Èπ „π°“√»÷°…“ƒ∑∏‘Ï ª«¥¢“ ¢“Àπ—° ¡’Õ“°“√§—π º‘«Àπ—ß∫√‘‡«≥¢âÕ‡∑â“Àπ“μ—«·≈–
¡“π·º≈¢Õߧ√’¡∫—«∫° ∑’Ë¡’ “√ °—¥„∫∫—«∫° 7% „π§π‰¢â ¡’ ’¥”§≈È” (lipoderma-tosclerosis) ·≈–À“°√ÿπ·√ß®–‡°‘¥

21 √“¬ ∑’ˉ¥â√—∫°“√ºà“μ—¥„À≠à∑“ß√–∫∫ªí “«– ·≈–¡’·º≈¬“« ‡ªìπ·º≈‰¥â ¡’√“¬ß“π°“√«‘®—¬∑“ߧ≈‘π‘°À≈“¬√“¬ß“π · ¥ß
10-23 ‡´π쑇¡μ√ ‚¥¬‡ª√’¬∫‡∑’¬∫°≈ÿà¡∑’Ë∑“§√’¡∫—«∫°∑—Èß·º≈ „Àâ‡ÀÁπ∂÷ߪ√– ‘∑∏‘º≈¢Õß total triterpenic fraction ¢Õß∫—«∫°
∑“§√’¡∫—«∫°·≈–¬“À≈Õ°Õ¬à“ß≈–§√÷Ëß·º≈ ·≈–∑“¬“À≈Õ° (TTFCA) ¢π“¥ 60-180 ¡°./«—π „π°“√∫√√‡∑“Õ“°“√¢Õß‚√§π’È

∑—Èß·º≈ «—π≈– 3-4 §√—Èß ‡ªìπ‡«≈“ 21 «—π æ∫«à“°≈ÿà¡·√°·º≈ ‚¥¬¡’§«“¡ —¡æ—π∏å°—∫¢π“¥¢Õß “√ °—¥∑’Ë„Àâ
À“¬¥’∑’Ë ÿ¥ à«π°≈ÿà¡∑’Ë„™â¬“À≈Õ°¡’·º≈À“¬‰¡à Ÿâ¥’ °“√∑“ O „πºŸâªÉ«¬§«“¡¥—π‚≈À‘μ„πÀ≈Õ¥‡≈◊Õ¥¥”∑’Ë¢“ Ÿß
41
À√◊Õ‰¡à∑“¬“„Àâº≈‡∑à“°—π “√ °—¥∫—«∫°™à«¬≈¥ capillary filtration rate, Õ“°“√∫«¡
„π°“√»÷°…“ª√– ‘∑∏‘º≈¢Õß “√ °—¥®“° ¢ÕߢâÕ‡∑â“, ∑”„Àâ microcirculation ∑’Ë¢“¢ÕߺŸâªÉ«¬¥’¢÷Èπ,
∫—«∫°™π‘¥√—∫ª√–∑“π∑’Ë¡’ “√ÕÕ°ƒ∑∏‘Ï¢Õß∫—«∫° 50 ¡‘≈≈‘°√—¡ ª√‘¡“μ√¢Õߢ“≈¥≈ß, ¿“«– venous microangiopathy ¥’
§√—Èß≈– 2 ·§ª´Ÿ≈À≈—ßÕ“À“√ 3 ‡«≈“ μàÕ°“√À“¬¢Õß·º≈∑’Ë ¢÷Èπ ·≈–™à«¬≈¥ capillary permeability ∑’ˇæ‘Ë¡¢÷Èπ„πºŸâªÉ«¬‚√§
46-48
‡∑â“„πºŸâªÉ«¬‡∫“À«“π 200 §π ‡∑’¬∫°—∫°≈ÿà¡∑’ˉ¥â√—∫¬“À≈Õ° π’È
æ∫«à“°≈ÿà¡∑’Ë√—∫ª√–∑“𬓠“√ °—¥∫—«∫°¡’°“√À“¬¢Õß·º≈∑’Ë O „πºŸâªÉ«¬ chronic venous insufficiency ™à«¬
42
‡√Á«¢÷Èπ ·≈–¡’°“√‡®√‘≠‡μ‘∫‚μ¢Õ߇π◊ÈÕ‡¬◊ËÕ∑’Ë·º≈º‘¥ª°μ‘πâÕ¬≈ß ≈¥Õ“°“√∫«¡¢Õߢ“ ·≈–§«“¡√Ÿâ ÷°Àπ—°∑’Ë¢“ ≈¥°“√¢¬“¬μ—«
49
2.2 ƒ∑∏‘Ï√—°…“·º≈„π∑“߇¥‘πÕ“À“√ ¢ÕßÀ≈Õ¥‡≈◊Õ¥¥” ≈¥ skin flux at rest ≈¥ PCO ·≈–
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‡¡◊ËÕ„Àâ titrated extract ¢Õß∫—«∫°·°àºŸâªÉ«¬‚√§ ‡æ‘Ë¡ PO ≈¥Õ—μ√“°“√∫«¡¢ÕߢâÕ‡∑â“ ·≈–≈¥ capillary fil-
2
51
·º≈„π°√–‡æ“–Õ“À“√·≈–≈”‰ â 15 √“¬ „π¢π“¥ 60 ¡°./§π tration
ª√–¡“≥ 93% ¢ÕߺŸâªÉ«¬¡’Õ“°“√¥’¢÷ÈπÕ¬à“ß™—¥‡®π ·≈–ª√–¡“≥ O ™à«¬≈¥®”π«π¢Õß circulating endothelial cells
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73% ¢Õß·º≈À“¬®“°°“√μ√«®¥â«¬°≈âÕß·≈–°“√©“¬√—ß ’ „πºŸâªÉ«¬ post-phlebitic syndrome
·≈–°“√„™â√à«¡°—∫¬“≈¥°√¥ ·≈– ‰´‡¡∑‘¥’π (cimetidine) O °“√»÷°…“„πºŸâªÉ«¬ superficial venous disease
44
„Àâº≈¥’¬‘Ëߢ÷Èπ°«à“°“√„™â “√ °—¥Õ¬à“߇¥’¬« ‡≈Á°πâÕ¬∂÷ߪ“π°≈“ß∑’Ë¡’‡ âπ‡≈◊Õ¥¢Õ¥∑’Ë¢“ ∑’ËμâÕ߇¥‘π∑“ߥ⫬
2.3 ƒ∑∏‘Ï√—°…“·º≈„𪓰 ‡§√◊ËÕß∫‘π™—Èπª√–À¬—¥‡ªìπ‡«≈“π“π ‡¡◊ËÕ„Àâ°‘π TTFA ¢π“¥ 60
°“√»÷°…“ª√– ‘∑∏‘º≈¢Õ߇®≈ “√ °—¥„∫∫—«∫° ¡°. «—π≈– 3 §√—Èß °àÕπ‡¥‘π∑“ß 2 «—π „π«—π‡¥‘π∑“ß ·≈–Õ’° 1
¥§«“¡‡¢â¡¢âπ 0.5, 1.0 ·≈– 2.0% „π°“√√—°…“·º≈„𪓰 «—πÀ≈—߇¥‘π∑“ß æ∫«à“ ™à«¬≈¥Õ—μ√“°“√∫«¡¢ÕߢâÕ‡∑â“ ≈¥

‡ª√’¬∫‡∑’¬∫°—∫º≈‘μ¿—≥±å¬“‰∑√·Õ¡´‘‚π‚≈π·Õ´‘‚∑‰π¥å (tri- °“√∫«¡πÈ” ·≈–≈¥°“√‡æ‘Ë¡¢÷Èπ¢Õß PCO ‡¡◊ËÕ‡∑’¬∫°—∫°≈ÿà¡
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