ผลของการกดจุด LI4 และ SP6 ต่อความเจ็บปวดในระยะที่หนึ่ง ของการคลอดในผู้คลอดครรภ์แรก

∫ ∑ «‘ ∑ ¬ “ ° “ √

∫ ∑ «‘ ∑ ¬ “ ° “ √ º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷Ëß ¢Õß°“√§≈Õ¥„πºŸâ§≈Õ¥§√√¿å·√°

∏π“æ√ °‘µµ‘‡ π’¬å æ¬.¡. (°“√º¥ÿߧ√√¿å¢—Èπ Ÿß) π—°»÷°…“欓∫“≈»“ µ√å¡À“∫—≥±‘µ “¢“°“√º¥ÿߧ√√¿å¢—Èπ Ÿß ¡À“«‘∑¬“≈—¬¡À‘¥≈ ‡Õ¡æ√ √µ‘π∏√ Ph.D. (Nursing) ºŸâ™à«¬»“ µ√“®“√¬å ©«’«√√≥ Õ¬Ÿà ”√“≠ Ph.D. (Nursing) ºŸâ™à«¬»“ µ√“®“√¬å ¿“§«‘™“ Ÿµ‘»“ µ√åπ√’‡«™«‘∑¬“ §≥–欓∫“≈»“ µ√å ¡À“«‘∑¬“≈—¬¡À‘¥≈ ¡™—¬ ‚°«‘∑‡®√‘≠°ÿ≈ æ.∫., «.«. Ÿµ‘»“ µ√å-π√’‡«™«‘∑¬“ Ÿµ‘π√’·æ∑¬å ‚√ß欓∫“≈°√ÿ߇∑æ§√‘ ‡µ’¬π

∫∑§—¥¬àÕ °“√»÷°…“π’ȇªìπ°“√‡ªìπ°“√«‘®—¬·∫∫∑¥≈Õß (Randomized Controlled Trial) ¡’«—µ∂ÿª√– ߧå‡æ◊ËÕ »÷°…“º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥„πºŸâ§≈Õ¥§√√¿å·√° °≈ÿࡵ—«Õ¬à“߇ªìπºŸâ§≈Õ¥∑’Ë¡“§≈Õ¥∑’Ë»Ÿπ¬åÕπ“¡—¬∑’Ë 8 ®—ßÀ«—¥ π§√ «√√§å √–À«à“߇¥◊Õπ ¡’π“§¡ - °√°Æ“§¡ 2554 ®”π«π 60 √“¬ ·∫à߇ªìπ°≈ÿà¡∑¥≈Õß (30 √“¬) °≈ÿࡧ«∫§ÿ¡ (30 √“¬) ‚¥¬°“√ ÿࡥ⫬‚ª√·°√¡ §Õ¡æ‘«‡µÕ√å °≈ÿà¡∑¥≈Õß®–‰¥â√—∫°“√°¥®ÿ¥ LI 4 ·≈– SP 6 ®ÿ¥≈– 5 π“∑’ √«¡ 4 ®ÿ¥ ‡ªìπ‡«≈“ 20 π“∑’ à«π „π°≈ÿࡧ«∫§ÿ¡®–‰¥â√—∫°“√ —¡º— ∑’Ë®ÿ¥‡¥’¬«°—π„π√–¬–‡«≈“∑’ˇ∑à“°—π ∑”°“√ª√–‡¡‘π√–¥—∫§«“¡ª«¥∑—ÈßÀ¡¥ 4 §√—Èß ‰¥â·°à °àÕπ°“√°¥®ÿ¥ À≈—ß°“√°¥®ÿ¥∑—π∑’ ∑’Ë 30 ·≈–60 π“∑’À≈—ß°¥®ÿ¥ ‚¥¬„™â‡§√◊ËÕß¡◊Õ«—¥§«“¡‡®Á∫ ª«¥„™â·∫∫«—¥§«“¡‡®Á∫ª«¥¥â«¬ “¬µ“ Visual Analogue Scale (VAS) «‘‡§√“–Àå¢âÕ¡Ÿ≈‚¥¬„™ââ ∂‘µ‘√âÕ¬≈– §à“‡©≈’ˬ §à“‡∫’ˬ߇∫π¡“µ√∞“π ∂‘µ‘‰§- ·§«√å (Chi-square) ·≈– ∂‘µ‘«‘‡§√“–À姫“¡·ª√ª√«π·∫∫«—¥´È” (Repeated Measures ANOVA) º≈°“√«‘®—¬ æ∫«à“√–¥—∫§«“¡‡®Á∫ª«¥„π°≈ÿà¡∑¥≈Õß≈¥≈ß°«à“°àÕπ °¥®ÿ¥Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (F= 8.645, p <.01) ·≈–√–¥—∫§«“¡‡®Á∫ª«¥¿“¬À≈—ß°“√°¥®ÿ¥πâÕ¬°«à“ °≈ÿࡧ«∫§ÿ¡Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (F=13.34, p <.01) ¢âÕ √ÿª®“°ß“π«‘®—¬§√—Èßπ’È · ¥ß„Àâ‡ÀÁπ«à“°“√°¥ ®ÿ¥ LI 4 ·≈– SP 6 ‡ªìπ°“√®—¥°“√§«“¡‡®Á∫ª«¥∑’Ë¡’ª√– ‘∑∏‘¿“æ –¥«° ·≈–ª≈Õ¥¿—¬ ´÷Ëß欓∫“≈ º¥ÿߧ√√¿åÀ√◊ÕºŸâ¥Ÿ·≈°“√§≈Õ¥∑’ˉ¥â√—∫°“√Ωñ°°“√°¥®ÿ¥ “¡“√∂𔉪‡ªìπ∑“߇≈◊Õ°Àπ÷Ëß„π°“√®—¥°“√§«“¡ ‡®Á∫ª«¥„Àâ°—∫ºŸâ§≈Õ¥‰¥â §” ”§—≠ : ‡®Á∫§√√¿å§≈Õ¥/°“√°¥®ÿ¥/°“√®—¥°“√§«“¡ª«¥ 68

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º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥„πºŸâ§≈Õ¥§√√¿å·√°

Effect of acupressure at LI 4 and SP 6 on labor pain in the first stage of Labor in primigravidarum.

Thanaporn Kittisenee M.N.S (Advanced Midwifery) Master of Nursing student, Advanced Midwifer, Mahidol University.

Ameporn Rathinthorn Ph.D. (Nursing) Assistant Professor Chaweewan Yusamran Ph.D. (Nursing) Assistant Professor Department of Obstertrics and Gynecology.

Somchai Kovitcharroenkul MD.,DIP.Thai Board of Obsterics and Gynecology.

Obstertrician at The Bangkok Christian Hospital.

Abstract This is a randomized controlled trial aimed at studying the effect of acupressure at LI 4 and SP 6 on labor pain in the first stage of labor in primigravidarum. The subjects were 60 primigravid women recruited from the Regional Health Promotion Center 8, Nakhonsawan, Thailand during March-July 2011 and randomly assigned by computer to treatment (30) and control groups (30).

Treatment group received the acupressure at LI 4 of both hands and SP 6 of both ankles for five minutes for a period of 20 minutes, while the control group received only touch at the same points.

Labor pain was measured by labor pain scale (Visual Analogue Scale: VAS) before acupressure and immediately, 30, and 60 minutes after intervention. Data were statistically analyzed by Chisquare and Repeated Measures ANOVA. The results showed that the treatment group reported their labor pain was statistically significantly relieved after receiving acupressure (F = 8.645, p<.01) and also they had relief which was significantly lower than the control group (F = 13.34, p< .01). In conclusion, this study showed that acupressure at LI 4 and SP 6 was an effective, feasible and safe pain management method. Nurse-midwives and other personnel who have received acupressure training can use this as an alternative method in pain management for their parturient clients.

Key Words : Labor Pain Acupressure Pain Management.

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

July - September 2012

69

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º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥„πºŸâ§≈Õ¥§√√¿å·√°

§«“¡º‘¥ª°µ‘¢Õß°“√µ°‰¢à·≈–ª√–®”‡¥◊Õπ∑’˺‘¥ ª°µ‘ à߇ √‘¡§«“¡°â“«Àπâ“¢Õß°“√§≈Õ¥ ™à«≈¥§«“¡‡®Á∫ª«¥„π√–¬–§≈Õ¥‰¥â16 ¥—ßπ—ÈπºŸâ«‘®—®÷ßµâÕß°“√»÷°…“∂÷ߺ≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥ „πºŸâ§≈Õ¥§√√¿å·√° §”∂“¡°“√«‘®—°“√°¥®ÿ¥ LI 4 ·≈– SP 6 ¡’º≈µàÕ§«“¡ ‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥„πºŸâ§≈Õ¥ §√√¿å·√°À√◊Õ‰¡à

«—µ∂ÿª√– ߧ尓√»÷°…“ ‡æ◊ËÕ»÷°…“º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥ „πºŸâ§≈Õ¥§√√¿å·√°

¡¡µ‘∞“π°“√«‘®—§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥ ºŸâ§≈Õ¥§√√¿å·√°∑’ˉ¥â√—∫°“√°¥®ÿ¥ LI 4 ·≈– SP 6 πâÕ¬°«à“ºŸâ§≈Õ¥§√√¿å·√°∑’ˉ¡à‰¥â√—∫°“√°¥®ÿ¥

°√Õ∫·π«§‘¥°“√«‘®—„π°“√»÷°…“«‘®—¬§√—Èßπ’ȺŸâ«‘®—¬‰¥â„™â∑ƒ…Æ’ §«∫§ÿ¡ª√–µŸ (gate control theory)17 ·≈– ∑ƒ…Æ’‡°’¬Ë «°—∫»“ µ√å°“√·æ∑¬å·ºπ®’π‡ªìπ°√Õ∫ ·π«§‘¥„π°“√∑”«‘®—¬ ´÷Ëß “¡“√∂π”¡“ª√–¬ÿ°µå „ ™â „ π ° “ √ ®— ¥ ° “ √ °— ∫ § « “ ¡ ‡ ®Á ∫ ª « ¥ ‚ ¥ ¬ ¡’ °√–∫«π°“√∑’Ë ”§—≠¥—ßπ’È ‚§√ß √â“ߢÕß√–∫∫ ª√– “∑ à«π°≈“ß ´÷Ëߪ√–°Õ∫‰ª¥â«¬„¬ª√– “∑ √—∫√Ÿâ¢π“¥„À≠à (A fibers) ·≈–¢π“¥‡≈Á° (C fibers) ∑’Ëπ”°√–· §«“¡‡®Á∫ª«¥ (pain impulse) ‡¢â“ Ÿà‰¢ —πÀ≈—ß (spinal cord) °â“π ¡Õß (brain stem) ·≈–‡ª≈◊Õ° ¡Õß (cerebral cortex) ´÷Ëß

‡ªìπ à«π∑’Ë·ª≈º≈∫√‘‡«≥‰¢ —πÀ≈—ß®–¡’°≈ÿࡇ´≈≈å ∑’ˇ√’¬°«à“ substantia gelatinosa Õ¬Ÿà„π dorsal horn ´÷Ëß®–¡’Àπâ“∑’˪î¥-‡ªî¥ª√–µŸ ‡¡◊ËÕ¡’°“√À¥ √—¥µ—«¢Õß¡¥≈Ÿ° À√◊Õ°“√¥÷ß√—ÈߢÕߪ“°¡¥≈Ÿ° ®– °√–µÿâπ‡ âπ„¬ª√– “∑¢π“¥‡≈Á°∑’Ëπ”°√–· §«“¡ ‡®Á ∫ ª«¥®“°°“√À¥√— ¥ µ— « ¢Õß¡¥≈Ÿ ° ·≈–ª“° ¡¥≈Ÿ°„Àâ¡®’ ”π«π¡“°°«à“‡ âπ„¬ª√– “∑¢π“¥„À≠à √–∫∫§«∫§ÿ¡ª√–µŸ®–‡ªî¥°√–· §«“¡‡®Á∫ª«¥°Á ®–∂Ÿ° à߉ª¬—ß ¡Õß ®÷ß∑”„À⇰‘¥°“√√—∫√Ÿâ«à“¡’ §«“¡‡®Á∫ª«¥ ·µà‡¡◊ËÕ¡’°“√∂Ÿ °“√π«¥ °“√°¥®ÿ¥ À√◊Õ°“√„™â§«“¡√âÕπ-§«“¡‡¬Áπ ®–°√–µÿâπ‡ âπ ª√– “∑„À≠à∑’ËÕ¬Ÿà∫√‘‡«≥‡π◊ÈÕ‡¬◊ËÕ¢Õߺ‘«Àπ—ß´÷Ëß®– π”°√–· ª√– “∑∑’ˇ√Á«¡“°°«à“°√–· ª√– “∑ ®“°„¬ª√– “∑‡≈Á ° √–∫∫§«∫§ÿ ¡ ª√–µŸ ® –ªî ¥ ∑”„Àâ°√–· ª√– “∑‰ª‰¡à∂÷ß ¡Õß®÷߉¡à∑”„À⇰‘¥ §«“¡‡®Á∫ª«¥17 πÕ°®“°π’È„¬ª√– “∑®“° ¡Õß ®–ª≈àÕ¬ “√‡§¡’‰ª°√–µÿâπ‡´≈≈å¢Õß Substantia gelatinosa „ÀâµÕà ¡ pituitary À≈—ßË “√ endorphins ´÷Ëß®–‰ª¬—∫¬—Èß°“√∑”ß“π¢Õß Substance P „π ‰¢ —πÀ≈—ß·≈– “√ ◊ËÕª√– “∑Õ◊ËπÊ ∑”„À≡ࡒ —≠≠“π‰ª°√–µÿâπ Transmission cell ∑”„Àâ °√–· ª√– “∑‰¡à∂°Ÿ à߉ª∑’ Ë ¡Õß à«π∏“≈“¡— ·≈– ‡ª≈◊Õ° ¡Õß ´÷Ë߇ªìπ à«π∑’Ë·ª≈§«“¡√Ÿâ ÷°‡®Á∫ª«¥ ®÷ß∑”„À⧫“¡‡®Á∫ª«¥≈¥≈߉¥â18,19 ¥â“π»“ µ√å °“√·æ∑¬å·ºπ®’πÕ∏‘∫“¬«à“ °“√°¥®ÿ¥™à«¬∑”„Àâ ‡≈◊Õ¥·≈–≈¡ª√“≥‰À≈‡«’¬π‰¥â –¥«°¢÷Èπ20 ´÷Ëß ‡¡◊ËÕ¡’°“√‰À≈‡«’¬π¢Õ߇≈◊Õ¥∑’Ë¥’¢÷Èπ®–™à«¬∑”„Àâ ‡≈◊Õ¥π”ÕÕ°´‘‡®π‰ª‡≈’È¬ß à«πµà“ßÊ ¢Õß√à“ß°“‚¥¬‡©æ“–∫√‘‡«≥¡¥≈Ÿ°¥’¢÷Èπ ∑”„Àâ°“√§—ËߢÕß ¢Õ߇ ’¬·≈–°√¥·≈§µ‘°≈¥≈ß ∑”„Àâ Substance P „π‰¢ —πÀ≈—ß·≈– “√ ◊ËÕª√– “∑Õ◊ËπÊ ≈¥≈ß ¡’º≈ „π°“√≈¥°“√°√–µÿâπ∑’Ë„¬ª√– “∑‡≈Á° ∑”„Àâ√–∫∫ §«∫§ÿ¡ª√–µŸ‰¡à‡ªî¥®÷߉¡à∑”„À⇰‘¥§«“¡‡®Á∫ª«¥4

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

July - September 2012

71

∫ ∑ «‘ ∑ ¬ “ ° “ √ «‘∏’°“√»÷°…“ °“√«‘ ®— ¬ §√—È ß π’È ‡ ªì π °“√«‘ ®— ¬ ·∫∫∑¥≈Õß (Randomized Controlled Trial) ≈—°…≥–ª√–™“°√·≈–°≈ÿࡵ—«Õ¬à“ß ª√–™“°√¢Õßß“π«‘®—¬π’Ȫ√–°Õ∫¥â«¬ºŸâ §≈Õ¥§√√¿å·√°Õ“¬ÿ§√√¿å√–À«à“ß 37-42 —ª¥“Àå ∑’Ë¡“§≈Õ¥∑’Ë»Ÿπ¬åÕπ“¡—¬∑’Ë 8 π§√ «√√§å §—¥‡≈◊Õ° ‡¢â“°≈ÿࡵ—«Õ¬à“ßµ“¡À≈—°‡°≥±å„π°“√§—¥‡¢â“·≈– ÕÕ°µ“¡∑’Ë°”Àπ¥‰«â¥—ßπ’È - À≈— ° ‡°≥±å „ π°“√§— ¥ ‡¢â “ §◊ Õ Õ“¬ÿ √–À«à “ ß 20-34 ªï ¿“æ ¡√ §Ÿà ‰¡à ¡’ ¿ “«– ·∑√°´âÕπ„¥Ê „π√–¬–µ—ßÈ §√√¿å ∑“√°Õ¬Ÿ„à π∑à“ª°µ‘ ¡’»’√…–‡ªìπ à«ππ” ¡’·ºπ°“√√—°…“„π°“√„Àâ §≈Õ¥∑“ß™àÕߧ≈Õ¥ Õ¬Ÿ„à π√–¬–‡®Á∫§√√¿å®√‘ß ª“° ¡¥≈Ÿ°‡ªî¥√–À«à“ß 1-3 ‡´πµ‘‡¡µ√ ‰¡à‰¥â√—∫¬“ ‡√àߧ≈Õ¥À√◊Õ¬“√–ß—∫ª«¥„¥Ê °àÕπ„Àâ°“√°¥®ÿ¥ - À≈—°‡°≥±å„π°“√§—¥ÕÕ° §◊Õ ∑“√°¡’ ¿“«–¢“¥ÕÕ°´‘‡®π (Fetal distress) - ¢π“¥¢Õß°≈ÿࡵ—«Õ¬à“ß °”Àπ¥¢π“¥ ¢Õß°≈ÿࡵ—«Õ¬à“ß‚¥¬„™â Power analysis21 ‚¥π”º≈°“√«‘®¬— ∑’ºË “à π¡“12 À“§à“¢π“¥Õ‘∑∏‘æ≈ (effect size À√◊Õ d) µ“¡ Ÿµ√¢Õß Hunter & Schmidt (1990) ®“°°“√§”π«≥‰¥â§à“ effect size = 0.8 ·≈–°”Àπ¥§à“ α = .05, power = .80 ¢π“¥°≈ÿࡵ—«Õ¬à“ß®“°°“√‡ªî¥µ“√“ß21 ®–„™â ¢π“¥°≈ÿࡵ—«Õ¬à“ß∑—ÈßÀ¡¥ 50 §π ·µà‡æ◊ËÕªÑÕß°—π °“√ Ÿ ≠ À“¬¢Õß°≈ÿà ¡ µ— « Õ¬à “ ß ºŸâ «‘ ®— ¬ ‰¥â ‡ æ‘Ë ¡ ®”π«πª√–™“°√Õ’° 10 % ‡æ√“–©–π—Èπ®–‰¥â ®”π«π°≈ÿࡵ—«Õ¬à“ß∑—ÈßÀ¡¥ 60 §π ·∫à߇ªìπ°≈ÿà¡ ∑¥≈Õß ·≈–°≈ÿࡧ«∫§ÿ¡°≈ÿà¡≈– 30 §π ‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√«‘®—‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√«‘®—¬§√—Èßπ’È¡’ 2 à«π§◊Õ 1. ‡§√◊ÕË ß¡◊Õ∑’„Ë ™â„π°“√¥”‡π‘π°“√«‘®¬— ‰¥â·°à ºŸâ«‘®—¬∑’ˇªìπºŸâ°¥®ÿ¥ LI 4 ·≈– SP 6 ‚¥¬ºŸâ«‘®—72

°√°Æ“§¡ - °—𬓬π 2555

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‰¥âºà“π°“√Ωñ°Õ∫√¡À≈—° Ÿµ√ ç°“√°¥®ÿ¥∫”∫—¥é (Acupressure) ®—¥‚¥¬ ”π—°°“√·æ∑¬å∑“߇≈◊Õ° °√–∑√«ß “∏“√≥ ÿ¢ ·≈–Ωñ°ªØ‘∫—µ‘„π°“√°¥®ÿ¥ °—∫·æ∑¬åºŸâ‡™’ˬ«™“≠∑’Ë‚√ß欓∫“≈»‘√‘√“™ 2. ‡§√◊ËÕß¡◊Õ∑’Ë„™â„π°“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈ ‰¥â·°à 2.1‡§√◊Ë Õ ß¡◊ Õ ∑’Ë „ ™â „ π°“√‡°Á ∫ √«∫√«¡ ¢âÕ¡Ÿ≈∑—Ë«‰ª¢ÕߺŸâ§≈Õ¥ ·∫àßÕÕ°‡ªìπ 3 à«π ª√–°Õ∫¥â«¬ ¢âÕ¡Ÿ≈ à«πµ—«‡°’¬Ë «°—∫ºŸ§â ≈Õ¥ ¢âÕ¡Ÿ≈ ‡°’ˬ«°—∫°“√µ—Èߧ√√¿å ¢âÕ¡Ÿ≈‡°’ˬ«°—∫º≈≈—æ∏å¢Õß °“√§≈Õ¥ 2.2‡§√◊ËÕß¡◊Õ„π°“√ª√–‡¡‘𧫓¡‡®Á∫ ª«¥ ºŸâ«‘®—¬‰¥â„™â·∫∫«—¥§«“¡‡®Á∫ª«¥¥â«¬ “¬µ“ Visual Analogue Scale (VAS)22 ‚¥¬¡’§à“µ—« ‡≈¢‡ªìπ ◊ËÕ ‡æ◊ËÕ· ¥ß∂÷ß√–¥—∫§«“¡√Ÿâ ÷°∑’˺Ÿâ§≈Õ¥ ¡’§«“¡‡®Á∫ª«¥‚¥¬„™â‡ âπµ√߬“« 10 ‡´πµ‘‡¡µ√ ‡√‘¡Ë µâπ∑’ªË ≈“¬¥â“π´â“¬·∑π§à“¥â«¬µ—«‡≈¢ 0 À¡“∂÷ß ‰¡àª«¥‡≈¬ ·≈–ª≈“¬ ÿ¥∑“ߥâ“π¢«“·∑π§à“ ¥â«¬µ—«‡≈¢ 100 À¡“¬∂÷ß ª«¥¡“°∑’Ë ÿ¥ ∑¥ Õ∫ §ÿ≥¿“æ¢Õ߇§√◊ËÕß¡◊Õ ‚¥¬À“§«“¡‡∑’ˬ߂¥¬°“√ ∑¥ Õ∫´È”„πºŸâ§≈Õ¥ ®”π«π 10 √“¬ ‰¥â§à“§«“¡ ‡∑’ˬ߇∑à“°—∫ 0.91 °“√æ‘∑—°…å ‘∑∏‘Ï¢Õß°≈ÿࡵ—«Õ¬à“ß °“√«‘®—¬§√—Èßπ’Ⱥà“π°“√æ‘®“√≥“·≈–‰¥â√—∫ °“√√—∫√Õß®“°§≥–°√√¡°“√®√‘¬∏√√¡°“√«‘®—¬„π §π¢Õß¡À“«‘∑¬“≈—¬¡À‘¥≈ ™ÿ¥ C “¬æ¬“∫“≈ »“ µ√å · ≈–®“°§≥–°√√¡°“√æ‘ ® “√≥“¥â “ π ®√‘¬∏√√¡„π°“√»÷°…“«‘®¬— „π§π ¢Õß»Ÿπ¬åÕπ“¡—¬∑’Ë 8 π§√ «√√§å °“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈ 1. ‡¡◊ËÕ‚§√ß√à“ß°“√«‘®—¬ºà“π°“√æ‘®“√≥“ ®“°§≥–°√√¡°“√®√‘¬∏√√¡°“√«‘®—¬„π§π ·≈–‰¥â √— ∫ °“√Õπÿ ≠ “µ„π°“√‡°Á ∫ ¢â Õ ¡Ÿ ≈ ·≈â « ºŸâ «‘ ®— ª√– “π¢Õ§«“¡√à«¡¡◊Õ„Àâ欓∫“≈„πÀâÕߧ≈Õ¥

º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥„πºŸâ§≈Õ¥§√√¿å·√°

‡ªìπºŸâª√–‡¡‘π√–¥—∫§«“¡‡®Á∫ª«¥¢ÕߺŸâ§≈Õ¥¥â«VAS °àÕπ·≈–À≈—ß°“√°¥®ÿ¥‚¥¬∑’Ë欓∫“≈„π ÀâÕߧ≈Õ¥‰¡à∑√“∫«à“ºŸâ√à«¡«‘®—¬Õ¬Ÿà„π°≈ÿà¡„¥ 2. ºŸâ «‘ ®— ¬ §— ¥ ‡≈◊ Õ °°≈ÿà ¡ µ— « Õ¬à “ ßµ“¡ §ÿ ≥ ¡∫— µ‘ ∑’Ë °”Àπ¥‰«â ·≈–·∫à ß °≈ÿà ¡ ‚¥¬„™â ‚ª√·°√¡§Õ¡æ‘«‡µÕ√å„π°“√ ÿà¡°≈ÿࡵ—«Õ¬à“߇¢â“ °≈ÿà¡∑¥≈Õß 30 §π·≈–°≈ÿࡧ«∫§ÿ¡ 30 §π (º≈ ® “ ° ° “ √ ÿà ¡ ° ≈ÿà ¡ µ— « Õ ¬à “ ß ¥â « ¬ ‚ ª √ · ° √ ¡ §Õ¡æ‘«‡µÕ√å®–∂Ÿ°∫√√®ÿÕ¬Ÿà„π´Õß®¥À¡“¬ µÕπ §— ¥ ‡¢â “ °≈ÿà ¡ µ— « Õ¬à “ ߺŸâ «‘ ®— ¬ ®–‰¡à ∑ √“∫«à “ °≈ÿà ¡ µ—«Õ¬à“ßπ’È®–∂Ÿ°‡≈◊Õ°„ÀâÕ¬Ÿà„π°≈ÿà¡„¥ ®–‡ªî¥´Õß ®¥À¡“¬‡¡◊ËÕ°≈ÿࡵ—«Õ¬à“ßπ—Èπ¬‘π¬Õ¡‡ªìπºŸâ√à«¡ «‘®—¬·≈â«) À≈—ß®“°π—È𥔇π‘π°“√∑¥≈Õß ‚¥¬¡’ ¢—ÈπµÕπ¥—ßπ’È °≈ÿ¡à ∑¥≈Õß 1. ºŸâ«‘®—¬·π–π”µ—«‡Õß ¢Õ§«“¡√à«¡¡◊Õ„π °“√«‘®—¬®“°ºŸâ§≈Õ¥ ·≈–Õ∏‘∫“¬∂÷ß«—µ∂ÿª√– ß§å ¢Õß°“√∑”«‘®—¬ ¢—ÈπµÕπ°“√≈¥ª«¥¥â«¬«‘∏’°“√°¥ ®ÿ¥ °“√ª√–‡¡‘πº≈§«“¡‡®Á∫ª«¥°àÕπ·≈–À≈—ß °“√∑¥≈Õß ‡¡◊ËÕºŸâ§≈Õ¥µÕ∫µ°≈ß ·≈–‡´Áπµå„∫ ¬‘π¬Õ¡‡¢â“√à«¡°“√«‘®—¬ ºŸâ«‘®—¬∫—π∑÷°¢âÕ¡Ÿ≈∑—Ë«‰ª ¢ÕߺŸâ§≈Õ¥ 2. ‡¡◊Ë Õ ª“°¡¥≈Ÿ ° ‡ªî ¥ 3 ‡´πµ‘ ‡ ¡µ√ 欓∫“≈„πÀâÕߧ≈Õ¥∑”°“√ª√–‡¡‘𧫓¡‡®Á∫ ª«¥°àÕπ„Àâ°“√∑¥≈Õߥ⫬°“√„™â‡§√◊ËÕß¡◊Õ«—¥ §«“¡‡®Á ∫ ª«¥¥â « ¬ “¬µ“ (VAS) (‚¥¬∑’Ë æ¬“∫“≈„πÀâ Õ ß§≈Õ¥‰¡à ∑ √“∫«à “ ºŸâ § ≈Õ¥Õ¬Ÿà „ π °≈ÿà¡∑¥≈ÕßÀ√◊Õ§«∫§ÿ¡) 3. ºŸâ «‘ ®— ¬ ∑”°“√°¥®ÿ ¥ LI4 ∫√‘ ‡ «≥ √–À«à“ßßà“¡π‘È«À—«·¡à¡◊Õ·≈–π‘È«™’È∑—Èß Õߢâ“ß ‚¥∑”∑’≈–¢â“ß ·≈–°¥®ÿ¥ SP6 ∫√‘‡«≥‡Àπ◊Õµ“µÿà¡ ¥â“π„π¢÷Èπ¡“ 4 π‘È«¡◊Õ∑—Èß Õߢâ“ß ∑”∑’≈–¢â“߇™à𠇥’¬«°—π ‚¥¬„™âπ‘È«À—«·¡à¡◊Õ°¥∫√‘‡«≥¥—ß°≈à“« „™â ·√ß„π°“√°¥∑’Ë 3-5 °‘‚≈°√—¡ À√◊Õ Õ∫∂“¡§«“¡

√Ÿ â °÷ ¢ÕߺŸ∂â °Ÿ °¥®ÿ¥«à“ ¡’§«“¡√Ÿ â °÷ ª«¥Àπ—° Ê ª«¥ µ◊ÈÕ Ê À√◊Õ‡°‘¥§«“¡√Ÿâ ÷° ç·≈àπé ÕÕ°®“°®ÿ¥∑’Ë°¥ À√◊Õ‰¡à ∂â“¡’§«“¡√Ÿâ ÷°‡À≈à“π’È· ¥ß«à“°¥∂Ÿ°®ÿ¥ ·≈–¢π“¥·√ß∑’°Ë ¥‡À¡“– ¡‚¥¬°¥ 10 «‘π“∑’ ·≈– ª≈àÕ¬ 2 «‘π“∑’ ®π§√∫ 5 π“∑’ ∑”°“√°¥∑’≈–®ÿ¥ ∑—ÈßÀ¡¥ 4 ®ÿ¥ „™â‡«≈“„π°“√°¥∑—Èß ‘Èπ 20 π“∑’9 4. ª√–‡¡‘ π √–¥— ∫ §«“¡ª«¥À≈— ß °“√ ∑¥≈Õß∑—π∑’¥â«¬ VAS ∑—π∑’À≈—ß°¥®ÿ¥ ·≈–∑’Ë 30 ·≈– 60 π“∑’À≈—ß°¥®ÿ¥ ‚¥¬æ¬“∫“≈∑’˪ؑ∫—µ‘ß“π „πÀâÕߧ≈Õ¥ (‚¥¬∑’Ë欓∫“≈„πÀâÕߧ≈Õ¥‰¡à ∑√“∫«à“ºŸâ§≈Õ¥Õ¬Ÿà„π°≈ÿà¡∑¥≈ÕßÀ√◊Õ§«∫§ÿ¡) °≈ÿࡧ«∫§ÿ¡ ¥”‡π‘ π °“√∑¥≈Õ߇À¡◊ Õ π°— π °— ∫ °≈ÿà ¡ ∑¥≈Õß∑—Èßµ”·Àπàß √–¬–‡«≈“ °“√ª√–‡¡‘𧫓¡ ª«¥∑—Èß°àÕπ·≈–À≈—ß°“√∑¥≈Õß ®–·µ°µà“ß°—π∑’Ë °≈ÿࡧ«∫§ÿ¡®–„™â‡æ’¬ß°“√ —¡º— ‚¥¬‰¡à¡’·√ß°¥∑’Ë ®ÿ¥ LI 4 ·≈– SP6 °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈ 6.1 «‘‡§√“–Àå¢âÕ¡Ÿ≈ à«πµ—«·≈–¢âÕ¡Ÿ≈ ‡°’ˬ«°—∫°“√§≈Õ¥ ‰¥â·°à Õ“¬ÿ Õ“™’æ √–¥—∫°“√ »÷°…“ ≈—°…≥–¢Õß°“√§≈Õ¥ √–¬–‡«≈“¢Õß°“√ §≈Õ¥ ¿“«–·∑√°´âÕπ„π√–¬–√Õ§≈Õ¥ °“√‰¥â√—∫ ¬“∫√√‡∑“§«“¡‡®Á ∫ ª«¥·≈–°“√‰¥â √— ∫ ¬“‡√à ß §≈Õ¥¿“¬À≈—ß°“√°¥®ÿ¥ πÈ”Àπ—°¢Õß∑“√°·√°‡°‘¥ ‡æ» §–·ππ·Õæ°“√å °Õ√å∑’Ë 1 ·≈– 5 π“∑’ ‚¥°“√·®°·®ß§«“¡∂’Ë √âÕ¬≈– §à“‡©≈’ˬ ‰§- ·§«√å (Chi-square) ·≈– Independent t-test 6.2 ‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ߢÕß§à“ ‡©≈’ˬ§«“¡‡®Á∫ª«¥„π√–¬–§≈Õ¥¿“¬„π°≈ÿà¡·≈– √–À«à“ß°≈ÿࡥ⫬ ∂‘µ‘ Repeated Measures ANOVA

º≈°“√»÷°…“ ≈—°…≥–¢Õß°≈ÿࡵ—«Õ¬à“ß„π°“√»÷°…“«‘®—¬

THAILAND JOURNAL OF HEALTH PROMOTION AND ENVIRONMENTAL HEALTH

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∫ ∑ «‘ ∑ ¬ “ ° “ √ §√—ßÈ π’æÈ ∫«à“ à«π„À≠à¡Õ’ “¬ÿ√–À«à“ß 20-25 ªï Õ“¬ÿ ‡©≈’ˬ‡∑à“°—∫ 25.17 ªï ·≈–¡’√–¥—∫°“√»÷°…“ Ÿß °«à“¡—∏¬¡»÷°…“ (√âÕ¬≈– 60) Õ“™’æ√—∫®â“ß∑—Ë«‰ª (√âÕ¬≈– 30) ®“°°“√»÷°…“¢âÕ¡Ÿ≈°“√Ω“°§√√¿å æ∫«à“ à«π„À≠àΩ“°§√√¿åÕ¬Ÿ„à π™à«ß 6-10 §√—ßÈ Ω“° §√√¿å‡©≈’ˬ 9.22 §√—Èß (SD = 2.41) ¡’°“√‡µ√’¬¡ µ—«°àÕπ§≈Õ¥‚¥¬°“√‡¢â“‚√߇√’¬πæàÕ·¡à (√âÕ¬≈– 70) ·≈– à«π„À≠à‰¡à¡’Õ“°“√º‘¥ª°µ‘√–À«à“ß°“√ µ—Èߧ√√¿å (√âÕ¬≈– 95) ¢âÕ¡Ÿ≈¥â“πº≈≈—æ∏å¢Õß°“√§≈Õ¥ æ∫«à“ºŸâ §≈Õ¥ à«π„À≠à§≈Õ¥ª°µ‘ (√âÕ¬≈– 73.3) √–¬– ‡«≈“§≈Õ¥‡©≈’¬Ë „π°≈ÿ¡à ∑¥≈Õ߇∑à“°—∫ 4.43 (SD= 1.69) ·≈–°≈ÿࡧ«∫§ÿ¡‡∑à“°—∫ 5.04 (SD = 2.39) ‰¡àæ∫¿“«–·∑√°´âÕπ„¥Ê „π√–¬–§≈Õ¥ ·≈– à«π„À≠à‰¡à‰¥â√∫— ¬“‡√àߧ≈Õ¥ (√âÕ¬≈– 70) ”À√—∫

°“√„™â¬“√–ß—∫§«“¡ª«¥π—Èπ∑—Èß 2 °≈ÿà¡ ‰¡à¡’°≈ÿà¡ µ—«Õ¬à“ß§π„¥‰¥â√∫— ¬“√–ß—∫§«“¡ª«¥‡≈¬ ‡π◊ÕË ß®“° ·π«∑“ߪؑ∫µ— ¢‘ ÕßÀâÕߧ≈Õ¥ »Ÿπ¬åÕπ“¡—¬∑’Ë 8 π—πÈ ‰¡à„™â¬“„π°“√√–ß—∫§«“¡ª«¥„Àâ°—∫ºŸâ§≈Õ¥ „π à«π¢Õߺ≈≈—æ∏å¥â“π∑“√°æ∫«à“ πÈ”Àπ—°∑“√° à«π„À≠àÕ¬Ÿà„π™à«ß 2,501 - 3,500 °√—¡ (√âÕ¬≈– 86.6) πÈ”Àπ—°∑“√°‡©≈’ˬ 3,157 °√—¡ (SD = 331.67) §–·ππ·Õæ°“√å∑’Ë 1 ·≈– 5 π“∑’¢Õß ∑“√°∑—ÈßÀ¡¥Õ¬Ÿà„π™à«ß 8 - 10 ‡¡◊Ë Õ ∑¥ Õ∫§«“¡·µ°µà “ ß≈— ° …≥–¢Õß °≈ÿࡵ—«Õ¬à“ß·≈–¢âÕ¡Ÿ≈¥â“πº≈≈—æ∏å¢Õß°“√§≈Õ¥ √–À«à“ß°≈ÿ¡à §«∫§ÿ¡·≈–°≈ÿ¡à ∑¥≈Õߥ⫬ ∂‘µ‘ ChiSquare ·≈– Independent t-test æ∫«à“‰¡à¡’ §«“¡·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘

µ“√“ß∑’Ë 1 ‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ߢÕß§à“‡©≈’ˬ§«“¡ª«¥√–À«à“ß°≈ÿࡵ“¡·µà≈–™à«ß‡«≈“ °≈ÿࡧ«∫§ÿ¡ °≈ÿ¡à ∑¥≈Õß §«“¡ª«¥

MD (SD) X (SD)

°àÕπ°“√∑¥≈Õß (T1) À≈—ß°“√∑¥≈Õß∑—π∑’ (T2) À≈—ß°“√∑¥≈Õß 30 π“∑’ (T3) À≈—ß°“√∑¥≈Õß 60 π“∑’ (T4)

70.53 (17.46) 75.40 (18.75) 79.43 (18.99) 84.13 (16.86)

°“√≈¥§«“¡‡®Á∫ª«¥„π√–¬–§≈Õ¥ µ“√“ß∑’Ë 1 ‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ߢÕß §à“‡©≈’ˬ§«“¡ª«¥√–À«à“ß°≈ÿࡧ«∫§ÿ¡·≈–°≈ÿà¡ ∑¥≈Õßµ“¡·µà ≈ –™à « ߇«≈“ º≈æ∫«à “ °à Õ π°“√ ∑¥≈Õß ¡’§«“¡·µ°µà“ߢÕß§à“‡©≈’ˬ§«“¡ª«¥ ‡∑à“°—∫ 3.67 (SD = 4.60) ‡ª√’¬∫‡∑’¬∫§«“¡ ·µ°µà“ß‚¥¬„™â ∂‘µ‘ Repeated Measure ANOVA æ∫«à“ ‰¡à¡’§«“¡·µ°µà“ߢÕß§à“‡©≈’ˬ§«“¡ª«¥ √–À«à “ ß°≈ÿà ¡ §«∫§ÿ ¡ ·≈–°≈ÿà ¡ ∑¥≈ÕßÕ¬à “ ß¡’ π— 74

°√°Æ“§¡ - °—𬓬π 2555

°√¡Õπ“¡—¬ à߇ √‘¡„Àâ§π‰∑¬ ÿ¢¿“楒

P value

X (SD) 66.87 (18.17) 3.67 (4.60) 52.30 (17.81) 23.10 (4.72) 62.53 (16.22) 16.90 (4.56) 70.03 (14.87) 14.10 (4.10)

.429 <.001 <.001 .001

”§—≠∑“ß ∂‘µ‘ (p = .43) ”À√—∫§«“¡·µ°µà“ß ¢Õß§à“‡©≈’ˬ§«“¡ª«¥À≈—ß°“√∑¥≈Õß∑—π∑’ ·≈–∑’Ë 30 ·≈– 60 π“∑’ ‡∑à“°—∫ 3.67, 23.10 ·≈– 14.10 (SD = 4.60, 4.72 ·≈– 4.10) µ“¡≈”¥—∫ ‡ª√’¬∫ ‡∑’¬∫§«“¡·µ°µà“ß‚¥¬„™â ∂‘µ‘ Repeated Measure ANOVA æ∫«à“¡’§«“¡·µ°µà“ßÕ¬à“ß¡’𗔧—≠∑“ß ∂‘µ‘ (p < .001) ‚¥¬∑’Ë°≈ÿà¡∑¥≈Õß¡’ §à“‡©≈’ˬ§«“¡ª«¥À≈—ß°“√∑¥≈ÕßπâÕ¬°«à“°≈ÿà¡ §«∫§ÿ¡∑—Èß 3 √–¬– (·ºπ¿“æ∑’Ë 1)

º≈¢Õß°“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π√–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥„πºŸâ§≈Õ¥§√√¿å·√°

µ“√“ß∑’Ë 2 ‡ª√’¬∫‡∑’¬∫§«“¡·µ°µà“ߧ–·ππ‡©≈’¬Ë §«“¡ª«¥¿“¬„π°≈ÿ¡à §«∫§ÿ¡·≈–°≈ÿ¡à ∑¥≈Õß ‚¥¬„™â ∂‘µ‘ Repeated Measures ANOVA ·À≈àߧ«“¡·ª√ª√«π

¿“¬„π°≈ÿà¡ (Time) ‡«≈“ ‡«≈“*°≈ÿ¡à √–À«à“ß°≈ÿà¡ °≈ÿà¡

SS

df

MS

Fa

Partial P value Eta Squareda

6265.667 2576.983

1.9 3296.982 1.9 1356.004

21.019 8.645

0.266 0.13

<.001 <.001

12644.017

1 12644.02

13.34

0.19

<.001

SS = Sum Square; df = degree of freedom;

MS = Mean Square, a = Greenhouse-Geisser correction

®“°µ“√“ß∑’Ë 2 æ∫«à“ °“√∑¥ Õ∫§«“¡ ·µ°µà“ߢÕß§à“‡©≈’ˬ§«“¡ª«¥æ∫«à“ µ—«·ª√ ‡√◊ËÕ߇«≈“ (Time) ¡’º≈µàÕ§à“‡©≈’ˬ§«“¡ª«¥ ¿“¬„π°≈ÿ¡à Õ¬à“ß¡’π¬— ”§—≠∑“ß ∂‘µ‘ (F = 21.02, p<.001) ·≈–¬—ßæ∫«à“ªÆ‘ —¡æ—π∏å√–À«à“ßµ—«·ª√ ‡√◊ÕË ß‡«≈“ ·≈– µ—«·ª√‡√◊ÕË ß°≈ÿ¡à (Time*Case Interaction) °Á ¡’ § «“¡·µ°µà “ ß°— π Õ¬à “ ß¡’ π— ¬

”§—≠∑“ß ∂‘µ‘ (F = 8.64, p<.001) ·≈–‡¡◊ËÕ ∑¥ Õ∫§«“¡·µ°µà“ߢÕß§à“‡©≈’ˬ§«“¡ª«¥¢Õß ºŸ§â ≈Õ¥√–À«à“ß°≈ÿ¡à ∑¥≈Õß∑’‰Ë ¥â√∫— °“√°¥®ÿ¥ LI 4 ·≈– SP 6 ·≈–°≈ÿࡧ«∫§ÿ¡∑’ˉ¥â√—∫°“√ —¡º— ∑’Ë®ÿ¥ LI 4 ·≈– SP 6 °Á¡’§«“¡·µ°µà“ßÕ¬à“ß¡’𗔧—≠∑“ß ∂‘µ‘ (F = 13.34, p<.019) ‚¥¬°≈ÿà¡ ∑¥≈Õß∑’‰Ë ¥â√∫— °“√°¥®ÿ¥¡’§“à ‡©≈’¬Ë §«“¡ª«¥ πâÕ¬

·ºπ¿“æ∑’Ë 1 ‡ª√’¬∫‡∑’¬∫§–·ππ‡©≈’ˬ§«“¡ª«¥√–À«à“ß°≈ÿࡧ«∫§ÿ¡·≈–°≈ÿà¡∑¥≈Õß

À¡“¬‡Àµÿ T1 = §–·ππ‡©≈’ˬ§«“¡ª«¥°àÕπ°“√∑¥≈Õß T3 = §–·ππ‡©≈’ˬ§«“¡ª«¥À≈—ß°“√∑¥≈Õß 30 π“∑’

T2 = §–·ππ‡©≈’ˬ§«“¡ª«¥À≈—ß°“√∑¥≈Õß∑—π∑’ T4 = §–·ππ‡©≈’ˬ§«“¡ª«¥À≈—ß°“√∑¥≈Õß 60 π“∑’

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∫ ∑ «‘ ∑ ¬ “ ° “ √ °«à“°≈ÿà¡∑¥≈Õß∑’ˉ¥â√—∫°“√ —¡º— (·ºπ¿“æ∑’Ë 1)

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¬—∫¬—Èß°“√∑”ß“π¢Õß Substance P „π‰¢ —πÀ≈—ß ·≈– “√ ◊ËÕª√– “∑Õ◊ËπÊ ∑”„À≡ࡒ —≠≠“π‰ª °√–µÿâπ Transmission cell (T cell) ∑”„Àâ °√–· ª√– “∑‰¡à∂°Ÿ à߉ª∑’ Ë ¡Õß à«π∏“≈“¡— ·≈– ‡ª≈◊Õ° ¡Õß ´÷Ë߇ªìπ à«π∑’Ë·ª≈§«“¡√Ÿâ ÷°‡®Á∫ª«¥ ®÷ß∑”„À⧫“¡‡®Á∫ª«¥≈¥≈߉¥â17 πÕ°®“°π—Èπ°“√ °¥®ÿ ¥ ¬— ß ™à « ¬∑”„Àâ ° “√‰À≈‡«’ ¬ π¢Õ߇≈◊ Õ ¥·≈– æ≈—ßß“π‰À≈‡«’¬π‰¥â¥’¢÷Èπ ∑”„Àâ°“√‰À≈‡«’¬π¢Õß ÕÕ°´‘‡®π‰ª‡≈’È¬ß à«πµà“ßÊ ¢Õß√à“ß°“¬ ‚¥‡©æ“–∫√‘‡«≥¡¥≈Ÿ°¥’¢÷Èπ ∑”„Àâ°“√§—ËߢÕߢÕß ‡ ’¬·≈–°√¥·≈°µ‘§≈¥≈ß4 ∑”„À⧫“¡ª«¥≈¥≈߉¥â º≈®“°°“√»÷°…“§√—Èßπ’È “¡“√∂¬◊π¬—π∂÷ߺ≈¢Õß °“√°¥®ÿ¥ LI 4 ·≈– SP 6 µàÕ§«“¡‡®Á∫ª«¥„π √–¬–∑’ËÀπ÷ËߢÕß°“√§≈Õ¥¢ÕߺŸâ§≈Õ¥§√√¿å·√°´÷Ëß Õ¥§≈âÕß°—∫ß“π«‘®¬— Õ◊πË Ê ∑’ºË “à π¡“9,10,11,12,13 ‡ªìπ «‘ ∏’ ®— ¥ °“√§«“¡ª«¥∑’Ë ¡’ ª √– ‘ ∑ ∏‘ ¿ “æ –¥«° ª√–À¬— ¥ ª≈Õ¥¿— ¬ ‰¡à æ ∫Õ— π µ√“¬·≈–¿“«– ·∑√°´âÕπ„¥Ê ∑’ˇ°‘¥¢÷Èπ°—∫¡“√¥“·≈–∑“√°À≈—ß °“√°¥®ÿ¥

¢âÕ‡ πÕ·π– 1. §«√¡’°“√ π—∫ πÿπ·π–π”„Àâ∫ÿ§≈“°√ „π∑’¡ ÿ¢¿“æ ‰¥âπ”°“√°¥®ÿ¥≈¥ª«¥º ¡º “π ‡¢â“°—∫°“√¥Ÿ·≈·ºπªí®®ÿ∫—π ‡æ◊ËÕ„™â≈¥§«“¡∑ÿ°¢å ∑√¡“π®“°§«“¡‡®Á∫ª«¥„π√–¬–√Õ§≈Õ¥ 2. ‡π◊ËÕß®“°°“√°¥®ÿ¥„π√–¬–‡√‘Ë¡µâπ¢Õß °“√ª«¥®–¡’ª√– ‘∑∏‘º≈„π°“√≈¥ª«¥®–¥’°«à“°¥ ®ÿ¥µÕπ∑’˺Ÿâ§≈Õ¥¡’§«“¡ª«¥¡“° ¥—ßπ—Èπ欓∫“≈ ºŸ¥â ·Ÿ ≈°“√§≈Õ¥§«√ª√–‡¡‘𧫓¡‡®Á∫ª«¥∑ÿ° 1-2 ™¡. ·≈–°¥®ÿ¥´È”‰¥â‡¡◊ËÕºŸâ§≈Õ¥‡√‘Ë¡¡’§«“¡ª«¥

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