ประชุมวิชาการ ศิริราช 53

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ประชุมวิชาการ ศิริราช 53

  1. 1. iàǪÈÒʵÏ·¹Âؤ 2553 Ñ ºÃóҸԡÒà Á³Õ Ãѵ¹äªÂÒ¹¹·, ¾.º. ´ÒÃÒÇÃó ǹЪÔǹÒÇÔ¹, ¾.º. ÇÒ³Õ ÇÔÊ·¸ÔàÊÃÕǧȏ, ¾.º. Ø ì ÇÔ·Ã ªÔ¹ÊNjҧÇѲ¹¡ØÅ, ¾.º. Ù ÁÒ¹¾ ¾Ô·¡ÉÀÒ¡Ã, ¾.º. Ñ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÔÔ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ¾.È. 2553
  2. 2. àǪÈÒʵÏ·¹Âؤ 2553 ÑʧǹÅÔ¢ÊÔ·¸Ôì¨Ñ´¾ÔÁ¾ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÔÔ¨íҹǹ¾ÔÁ¾ 1,000 àŋÁ áÅÐ CD 4,000 Ἃ¹ ÊÔ§ËÒ¤Á 2553ISBN 978-974-11-1329-3¾ÔÁ¾·Õè ºÃÔÉ· ¾Õ.àÍ.ÅÕ¿ÇÔ§ ¨íÒ¡Ñ´ Ñ è 4 «ÍÂÊÔù¸Ã 7 ºÒ§¾ÅÑ´ ¡Ãا෾ÁËÒ¹¤Ã 10700 Ô â·ÃÈѾ· 0 2881 9890 â·ÃÊÒà 0 2881 9894
  3. 3. iii ¤íÒ¹íÒ Ë¹Ñ§Ê×Í “àǪÈÒʵϷѹÂؤ” ໚¹Ë¹Ñ§Ê×ÍàŋÁáá¢Í§â¤Ã§¡ÒõíÒÃÒÈÔÃÔÃÒª ·Õè¼ÅÔµ¢Öé¹ã¹ÅѡɳÐ໚¹ series ÃÒ»‚ ÁÕÇѵ¶Ø»ÃÐʧ¤à¾×èÍÃǺÃÇÁ¤ÇÒÁÃٌ·Ò§¡ÒÃᾷáÅÐà·¤â¹âÅÂÕ·Õà¡ÕÂÇ¢ŒÍ§ â´Â໚¹ËÑÇ¢ŒÍ·Õ·¹ÊÁÑÂáÅСíÒÅѧ䴌ú¤ÇÒÁʹã¨ã¹»‚¹¹æ à¾×ÍãˌÊÍ´¤ÅŒÍ§¡ÑºÊÀÒ¾¡Òó è è è Ñ Ñ Ñé è¢Í§¡ÒÃʋ§àÊÃÔÁáÅÐʹѺʹع¡ÒÃÈÖ¡ÉÒµ‹Íà¹×èͧ µÅÍ´¨¹Ê‹§àÊÃÔÁ¤ÇÒÁ¶Ù¡µŒÍ§áÅлÃÐÊÔ·¸ÔÀÒ¾¢Í§àǪ»¯ÔºµÔ Ñ »‚¾·¸ÈÑ¡ÃÒª 2553 ໚¹»‚·âçàÃÕ¹ᾷáˋ§áá¢Í§»ÃÐà·Èä·ÂÁÕÍÒÂؤú 120 »‚ áÅÐ Ø Õè໚¹»‚·Ë¹Ñ§Ê×ÍàǪÈÒʵÏ·¹ÂؤàŋÁáá¢Í§ series 䴌ແ´µÑǢֹ㹪×Í “àǪÈÒʵÏ·¹Âؤ 2553” Õè Ñ é è Ñ·Ñé § ¹Õé à ¾×è Í ãˌ Ë ¹Ñ § Ê× Í àǪÈÒʵÏ ·Ñ ¹ ÂØ ¤ àŋ Á áá¹Õé ÁÕ Ê‹ Ç ¹Ã‹ Ç Á㹡ÒÃà©ÅÔ Á ©ÅͧÇÒÃÐ´Ñ § ¡Å‹ Ò Ç¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ໚¹âçàÃÕ¹ᾷáˋ§áá¢Í§»ÃÐà·Èä·Â·Õè䴌ÃѺ¾ÃÐÁËÒ¡ÃسҸԤ³ ¨Ò¡Í§¤¾ÃлÃÐÁØ¢·Ø¡¾ÃÐͧ¤ 㹡ÒÃÊÒ¹µ‹Í¾ÃÐÃÒª»³Ô¸Ò¹áˋ§Í§¤¾ÃкҷÊÁà´ç¨ ؾÃлÃÁÔ ¹ ·ÃÁËÒ¨Ø Ì Òŧ¡Ã³ ¾ÃÐ¨Ø Å ¨ÍÁà¡ÅŒ Ò à¨Œ Ò ÍÂً ËÑ Ç ·Õè ä ´Œ · ç¾ÃСÃØ ³ Òâ»Ã´à¡ÅŒ Ò Ïແ´âçÈÔÃÃÒª¾ÂÒºÒÅã¹»‚¾·¸ÈÑ¡ÃÒª 2431 áÅÐແ´âçàÃÕ¹ᾷáˋ§áá㹻‚¾·¸ÈÑ¡ÃÒª 2433 Ô Ø Ø«Öè§ã¹»˜¨¨ØºÑ¹ÁÕª×èÍNjҤ³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å âçàÃÕ¹ᾷáˋ§¹Õé䴌·íÒ¡ÒüÅԵᾷáÅкؤÅҡ÷ҧ¡ÒÃᾷÍÍ¡ÊًÊѧ¤Áä·Â µÅÍ´¨¹Â×¹ËÂѴ㹡Ò÷íÒ˹ŒÒ·ÕèºíҺѴ´ÙáÅÃÑ¡ÉҼٻǠ¾Ñ²¹ÒÇÔªÒ¡ÒôŒÒ¹¡ÒÃᾷáÅСÒÃÊÒ¸ÒóÊØ¢ ãˌà¡Ô´¤ÇÒÁà¨ÃÔ­¡ŒÒÇ˹ŒÒ Œ †¤Çº¤Ù¡ºÊѧ¤Áä·ÂÁÒµÅÍ´ 120 »‚ ·Õ¼Ò¹ÁÒ ‹ Ñ è ‹ ˹ѧÊ×ÍàŋÁ¹Õ䴌ÃǺÃÇÁº·¤ÇÒÁ·Ò§ÇÔªÒ¡Òèҡ¤³Ð¼Ù¹¾¹¸«§à»š¹¼ÙàªÕÂǪҭ੾Òзҧ é Œ Ô Öè Œ è·Ñé§ÀÒÂã¹áÅÐÀÒ¹͡¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ à¹×èͧ¨Ò¡à¹×éÍËÒÇÔªÒã¹Ë¹Ñ§Ê×ÍàŋÁ¹ÕéÁÕ¤ÇÒÁËÅÒ¡ËÅÒÂÁÒ¡ ¡Í§ºÃóҸԡÒè֧䴌¨´ËÑÇ¢ŒÍµ‹Ò§æ ໚¹¡ÅØÁæ µÒÁÊÒ¢ÒÇÔªÒ Ñ ‹ ¡Í§ºÃóҸԡÒÃáÅФ³Ð¼ÙŒ¹Ô¾¹¸ÁÕ¤ÇÒÁÁ؋§ÁÑè¹·Õè¨Ð¹íÒ¤ÇÒÁÃٌ·Õè䴌ÃǺÃÇÁÁÒàÃÕºàÃÕ§໚¹Ë¹Ñ§Ê×Íà¾×Íãˌº¤Åҡ÷ҧ¡ÒÃᾷ·¡·‹Ò¹ÊÒÁÒö¹íÒä»ãªŒÍÒ§ÍÔ§ã¹àǪ»¯ÔºµÔ Íѹ¨Ð¡‹Íãˌà¡Ô´ è Ø Ø Œ Ñ»ÃÐ⪹Ê§ÊØ´µ‹Í¤Ø³ÀÒ¾ªÕǵ·Õ´¢Í§»Ç§ª¹ªÒÇä·Â Ù Ô è Õ ¡Í§ºÃóҸԡÒÃ
  4. 4. iv ¤íÒ¹ÔÂÁ “àǪÈÒʵϷѹÂؤ 2553” ໚¹Ë¹Ñ§Ê×Í·Ò§ÇÔªÒ¡Ò÷Õè¼ÅԵ໚¹ series ÃÒ»‚ àŋÁáá¢Í§â¤Ã§¡ÒõíÒÃÒÈÔÃÔÃÒª ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËԴŠ˹ѧÊ×ÍàŋÁ¹Õé䴌 à ǺÃÇÁ¤ÇÒÁÃٌ á ÅФÇÒÁ¡Œ Ò Ç˹Œ Ò ·Ò§¡ÒÃᾷ á ÅÐÊÒ¸ÒóÊØ ¢ â´Â䴌 ÃÑ º ¤ÇÒÁË Ç ÁÁ× Í໚¹Í‹ҧ´Õ§¨Ò¡¤³Ð¼Ù¹¾¹¸«§à»š¹¼ÙàªÕÂǪҭ੾Òзҧã¹ÃдѺ»ÃÐà·È·Ñ§ÀÒÂã¹áÅÐÀÒ¹͡ Ôè Œ Ô Öè Œ è 餳Ðá¾·ÂÈÒʵÏ ÈÔ ÃÔ Ã Òª¾ÂÒºÒÅ â´ÂÁ؋ § ์ ¹ ¡Òùí Ò Í§¤ ¤ ÇÒÁÃٌ ÇÔ · ÂÒ¡ÒÃáÅÐà·¤â¹âÅÂÕ·Ò§¡ÒÃᾷ··¹ÊÁÑÂáÅÐ໚¹àÅÔÈÁÒ»ÃÐÂØ¡µãªŒÍ‹ҧàËÁÒÐÊÁÊíÒËÃѺ¡ÒôÙáÅÊØ¢ÀÒ¾¢Í§¤¹ä·Â Õè Ñ ã¹¹ÒÁ¢Í§¤³º´Õ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ¡ÃмÁ¢Í¢Íº¤Ø³ ÔԡͧºÃóҸԡÒà áÅмٌ¹Ô¾¹¸·Ø¡·‹Ò¹·Õè䴌¨Ñ´·íÒãˌ˹ѧÊ×ÍàǪÈÒʵϷѹÂؤàŋÁ¹Õé ¡ÃмÁËÇѧ໚¹Í‹ҧÂÔè§Ç‹Ò˹ѧÊ×ÍàŋÁ¹Õé¨Ð໚¹»ÃÐ⪹µ‹Íᾷ ¾ÂÒºÒÅ áÅкؤÅҡ÷ҧ¡ÒÃᾷ·Ø¡ÊÒ¢Ò«Ö觨С‹Íãˌà¡Ô´»ÃÐ⪹ÊÙ§ÊØ´µ‹Í¤Ø³ÀÒ¾ªÕÇÔµ¢Í§ÁËÒª¹ªÒÇä·Â ãˌÊÍ´¤ÅŒÍ§¡Ñº»ÃÐà´ç¹ËÅÑ¡¢Í§¡Ô¨¡ÃÃÁ·Õèà©ÅÔÁ©ÅͧÇÒÃзÕèâçàÃÕ¹ᾷáˋ§áá¢Í§»ÃÐà·Èä·ÂÁÕÍÒÂؤú 120 »‚ ¤×͓âçàÃÕ¹ᾷÈÃÃÒªà¾×ÍÊѧ¤Á 120 »‚áˋ§¤ÇÒÁ¡ŒÒÇ˹ŒÒ” ÔÔ è ÈÒʵÃÒ¨ÒϤÅÔ¹¡¹ÒÂᾷ¸ÃÇѲ¹ ¡ØÅ·¹Ñ¹·¹ Ô Õ ¤³º´Õ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÔÔ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å
  5. 5. v ¡Í§ºÃóҸԡÒê×Í-Ê¡ØÅ è ´ÒÃÒÇÃó ǹЪÔǹÒÇÔ¹Çز¡ÒÃÈÖ¡ÉÒ Ô ¾.º., ».ªÑ¹ÊÙ§ (ÍÒÂØÃÈÒʵÏ), Ç.Ç. µ¨ÇÔ·ÂÒ, é Í.Ç. ¾ÂÒ¸ÔÇ·ÂÒ¤ÅÔ¹¡ Ô ÔµíÒá˹‹§·Ò§ÇÔªÒ¡Òà ÃͧÈÒʵÃÒ¨ÒÏ˹‹Ç§ҹ ÊÒ¢ÒÇÔªÒâ»Ã⵫ÑÇ ÀÒ¤ÇÔªÒ»ÃÊÔµÇÔ·ÂÒʶҺѹ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÔÔª×Í-Ê¡ØÅ è Á³Õ Ãѵ¹äªÂÒ¹¹·Çز¡ÒÃÈÖ¡ÉÒ Ô ¾.º., ».ªÑ¹ÊÙ§ (ÊÙµÈÒʵÏ-¹ÃÕàǪÇÔ·ÂÒ), Ç.Ç. ÊÙµÈÒʵÏ-¹ÃÕàǪÇÔ·ÂÒ, é Ô Ô Cert. .ellow in Reproductive Biology, Ç.Ç. àǪÈÒʵÏ¡ÒÃà¨ÃÔ­¾Ñ¹¸Ø, Í.Ç. àǪÈÒʵϤÃͺ¤ÃÑÇ, Ç·.Á. (¡ÒþѲ¹ÒÊØ¢ÀÒ¾)µíÒá˹‹§·Ò§ÇÔªÒ¡Òà ÈÒʵÃÒ¨ÒÏ˹‹Ç§ҹ ˹‹Çµ‹ÍÁäÌ·Í·Ò§¹ÃÕàǪ ÊÒ¢ÒÇÔªÒàǪÈÒʵÏ¡ÒÃà¨ÃÔ­¾Ñ¹¸Ø ‹ ÀÒ¤ÇÔªÒÊÙµÈÒʵÏ-¹ÃÕàǪÇÔ·ÂÒ ÔʶҺѹ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÔÔª×Í-Ê¡ØÅ è ÇÒ³Õ ÇÔÊ·¸ÔàÊÃÕǧȏ Ø ìÇز¡ÒÃÈÖ¡ÉÒ Ô ¾.º., ».ªÑ¹ÊÙ§ (¡ØÁÒÃàǪÈÒʵÏ), Ç.Ç. ¡ØÁÒÃàǪÈÒʵÏ, é Dip. of Dermatology, Cert. in Ped. Dermatology, Í.Ç. (àǪÈÒʵϤÃͺ¤ÃÑÇ), Í.Ç. (¡ØÁÒÃàǪÈÒʵÏ µ¨ÇÔ·ÂÒ)µíÒá˹‹§·Ò§ÇÔªÒ¡Òà ÃͧÈÒʵÃÒ¨ÒÏ˹‹Ç§ҹ ÊÒ¢Òâä¼ÔÇ˹ѧ ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵÏʶҺѹ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÔÔª×Í-Ê¡ØÅ è ÇÔ·Ã ªÔ¹ÊNjҧÇѲ¹¡ØÅ ÙÇز¡ÒÃÈÖ¡ÉÒ Ô ¾.º., Ç.Ç.(ÈÑÅÂÈÒʵÏ), Ph.D. (London)µíÒá˹‹§·Ò§ÇÔªÒ¡Òà ÍÒ¨ÒÏ˹‹Ç§ҹ ÊÒ¢ÒÇÔªÒÈÑÅÂÈÒʵÏ·Çä» ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏ ÑèʶҺѹ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÔÔ
  6. 6. viª×Í-Ê¡ØÅ è ÁÒ¹¾ ¾Ô·¡ÉÀÒ¡Ã ÑÇز¡ÒÃÈÖ¡ÉÒ Ô ¾.º., Í.Ç.(ÍÒÂØÃÈÒʵÏ) Diplomate, American Board of Internal Medicine Diplomate, American Board of Medical Genetics .ellowship in Clinical Genetics and Clinical Molecular GeneticsµíÒá˹‹§·Ò§ÇÔªÒ¡Òà ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ Œ ‹Ë¹‹Ç§ҹ ÊÒ¢ÒÇÔªÒàǪ¾Ñ¹¸ØÈÒʵÏ ÀÒ¤ÇÔªÒÍÒÂØÃÈÒʵÏʶҺѹ ¤³Ðá¾·ÂÈÒʵÏÈÃÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÔÔ
  7. 7. vii ÃÒ¹ÒÁ¼ÙŒ¹Ô¾¹¸Wei Mei Ching ¡Ñ­­·Í§ ·Í§ãË­‹ Doctor ÍÒ¨ÒÏ ᾷ˭ԧ ËÁ‹ÍÁËÅǧ Viral and Rickettsial Diseases Department ÀÒ¤ÇÔªÒâʵ ¹ÒÊÔ¡ ÅÒÃÔ§«Ç·ÂÒ Ô Naval Medical Research Center, MD, USA ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å¡¹¡ÇÃó ºØ­­¾ÔÊ®°ŠÔ ÃͧÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ à¡ÃÕ§ÈÑ¡´Ôì ¨ÕÃÐᾷ ÀÒ¤ÇÔªÒÍÒÂØÃÈÒʵÏ ÈÒʵÃÒ¨ÒÏ ¹ÒÂᾷ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵÏ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å¡ÁŷԾ ËÒ­¼´Ø§¡Ô¨ ÃͧÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ ¤íÒÁØ¡ ¤ÃͧÂØ·¸ ÀÒ¤ÇÔªÒàǪÈÒʵÏ¿¹¿Ù „œ ¹Ò§ÊÒÇ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÀÒ¤ÇÔªÒÃѧÊÕÇ·ÂÒ Ô ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å¡ÅÕºÊäº ÊÃþ¡Ô¨ ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ Œ ‹ ¨Ñ¹¨ÔÃÒ à¾ªÃÊØ¢ÈÔÃÔ ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵÏ ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ Œ ‹ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÀÒ¤ÇÔªÒÃѧÊÕÇ·ÂÒ Ô ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å¡ŒÍ§à¢µ àËÃÕ­ÊØÇÃó ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ¹ÒÂᾷ Œ ‹ ¨Ñ¹·¹ÃÑÈÁ ¨Ñ¹·¹Âԧ§ è ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏÍÍÏ⸻´Ô¤ÊáÅÐ ÍÒ¨ÒÏ ᾷ˭ԧ ¡ÒÂÀÒ¾ºíҺѴ ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏÍÍÏ⸻´Ô¤ÊáÅÐ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¡ÒÂÀÒ¾ºíҺѴ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å
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  17. 17. xviiÊØªÒ´Ò ÍÔ¹·ÇÔDz¹ Ñ ÊØǨ¹Ò ͸ÔÀÒÊ Ñ ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ Œ ‹ ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ Œ ‹ ÀÒ¤ÇÔªÒÊÙµÈÒʵÏ-¹ÃÕàǪÇÔ·ÂÒ Ô ÀÒ¤ÇÔªÒâʵ ¹ÒÊÔ¡ ÅÒÃÔ§«Ç·ÂÒ Ô ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÊع¹· ͧÍÒ¨ Ñ Í¹Ñ­­ ྱdzԪ ÍÒ¨ÒÏ ᾷ˭ԧ ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ¹ÒÂᾷ Œ ‹ ÀÒ¤ÇÔªÒâʵ ¹ÒÊÔ¡ ÅÒÃÔ§«Ç·ÂÒ Ô ÀÒ¤ÇÔªÒâʵ ¹ÒÊÔ¡ ÅÒÃÔ§«Ç·ÂÒ Ô ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÊØ»ÃÕªÒ ÍÑÊÇ¡Ò­¨¹ ÍÀÔªÒµÔ ¾ÔÈÒž§È ÍÒ¨ÒÏ ¹ÒÂᾷ ÍÒ¨ÒÏ ¹ÒÂᾷ ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏ ÀÒ¤ÇÔªÒÍÒÂØÃÈÒʵÏ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÊؾ¨¹ ¹ÔÁ͹§¤ è Í÷Ñ ¾ÔºÅâÀ¤Ò¹Ñ¹· Ù ÍÒ¨ÒÏ ¹ÒÂᾷ ÃͧÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ ÀÒ¤ÇÔªÒÍÒÂØÃÈÒʵÏ ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵÏ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÊØÁ¹ÑÊ ºØ³ÂÐÃѵàǪ ÍѤ¤¾§É ¹ÔµÊ§Ë Ô Ô ÍÒ¨ÒÏ ¹ÒÂᾷ ÍÒ¨ÒÏ ¹ÒÂᾷ ÀÒ¤ÇÔªÒµ¨ÇÔ·ÂÒ ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÊØÇÃÃ³Õ ÊØÃàÈóÕǧȏ ÍÑ­ªÅÕ ªÙâ蹏 ÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ ÃͧÈÒʵÃÒ¨ÒÏ ᾷ˭ԧ ÀÒ¤ÇÔªÒÇÔÊ­­ÕÇ·ÂÒ Ñ Ô ÀÒ¤ÇÔªÒÃѧÊÕÇ·ÂÒ Ô ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å
  18. 18. xviiiÍÑ°¾Ã µÃСÒÃʧ‹Ò ÍØäÃÇÃó ÈÔÅ»ÈØÀ¡Ãǧȏ ÍÒ¨ÒÏ ¹ÒÂᾷ àÀÊѪ¡ÃË­Ô§ ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏ ½†ÒÂàÀÊѪ¡ÃÃÁ âç¾ÂÒºÒÅÈÔÃÔÃÒª ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÍÑÉ®Ò àÁ¸àÈÃÉ° àÍ¡ÇØ²Ô ¨Ñ¹á¡ŒÇ ¼ÙªÇÂÈÒʵÃÒ¨ÒÏ ¹ÒÂᾷ Œ ‹ ÍÒ¨ÒÏ ¹ÒÂᾷ ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏ ÀÒ¤ÇÔªÒÈÑÅÂÈÒʵÏ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´ÅÍÒªÇÔ¹·Ã µÑ¹ä¾¨ÔµÃ ÍÒ¨ÒÏ ¹ÒÂᾷ ÀÒ¤ÇÔªÒâʵ ¹ÒÊÔ¡ ÅÒÃÔ§«Ç·ÂÒ Ô ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å
  19. 19. xix ÊÒúѭ ¤íÒ¹íÒ iii ¤íÒ¹ÔÂÁ iv ¡Í§ºÃóҸԡÒà v ÃÒ¹ÒÁ¼ÙŒ¹Ô¾¹¸ vii ËÑÇ¢ŒÍàÃ×èͧµÒÁÊÒ¢ÒÇÔªÒ¡ØÁÒÃàǪÈÒʵÏ 1 Childhood Seizure and Epilepsy 1 ÊÃÇÔÈ ÇÕÃÇÃó 2 ·Òá¡Ç¹¼Ô´»Ã¡µÔ 13 à¡ÃÕ§ÈÑ¡´Ôì ¨ÕÃÐᾷ 3 ¡ÒÃÇÔ¹¨©Ñ¡ÒÃᾌÍÒËÒÃÊíÒËÃѺàǪ»¯Ôºµ·Çä» Ô Ñ Ô Ñè 21 Í÷Ñ ¾ÔºÅâÀ¤Ò¹Ñ¹· ٨ѡÉØÇÔ·ÂÒ 4 Cultivated Epithelial Cell in Ophthalmology, When and How? 35 ÀÔ­¹ÔµÒ µÑ¹¸ØǹԵ, ³Ñ°¾Ã à·ÈÐÇÔºÅ, »˜·ÁÒ à͡⾸Ô,ì Á§¤Å ÍØ»ÃÐàÊÃÔ°¡ØÅ Ø 5 ¡ÒÃÃÑ¡ÉÒÀÒÇÐÊÒµҼԴ»¡µÔ´Ç LASIK: ÊÔ§¹‹ÒÃٹ͡à˹×ͨҡ¡Ò÷íÒàÅÊÔ¡ Œ è Œ 43 ³Ñ°ÇØ²Ô Ãʹ͹ѹµ, ʺ§ ÈÃÕÇÃóºÙó, ¹ÃÔÈ ¡Ô¨³Ã§¤ 6 New Era for Pediatric Eye Cancer Treatment 47 ÅÐÍͧÈÃÕ ÍѪª¹ÕÂÐÊ¡ØÅ 7 ¡ÒÃÃÑ¡ÉÒÁÐàÃ秨͵Òã¹à´ç¡´ŒÇÂÂÒà¤ÁպҺѴ í 51 à¨É®Ò ºÑǺح¹íÒ, ¡ÅÕºÊäº ÊÃþ¡Ô¨µ¨ÇÔ·ÂÒ 8 .ungal Skin Infection: A Neighborhood Touch 53 ÊØÁ¹ÑÊ ºØ­ÂÐÃѵàǪ 9 âäàª×ÍÃÒ·Õ¼Ç˹ѧªÑ¹ÅÖ¡ é è Ô é 59 à¾ç­Ç´Õ ¾Ñ²¹»ÃÕªÒ¡ØÅ
  20. 20. xxàÀÊѪÇÔ·ÂÒ10 ¡ÒÃà¡Ô´»¯Ô¡ÃÂÒÃÐËNjҧÂÒ·ÕÁ¤ÇÒÁÊíҤѭ·Ò§¤ÅÔ¹¡ ÔÔ è Õ Ô 69 ÊÁÄ´Õ ©ÑµÃÊÔÃà¨ÃÔ­¡ØÅ Ô11 Availability of Antidote: A Current Status in Thailand 75 ¸¹¡Ã ÈÔÃÊÁØ·Ã Ô12 Drug Administration Pitfalls: .rom Practitioner to Patient 81 »ÃÕªÒ Á¹·¡Ò¹µÔ¡Å Ø13 Drug Administration Pitfalls: Case Studies 87 ÍØäÃÇÃó ÈÔÅ»ÈØÀ¡Ãǧȏ14 ¡ÒÃ㪌 Trigger Tool 㹡Ò䌹ËÒáÅÐÇÑ´ÍѵÃÒà˵ءÒóäÁ‹¾§»ÃÐʧ¤ Ö 95 ¨Ò¡¡ÒÃ㪌ÂÒã¹âç¾ÂÒºÒÅ ÇÕÃÇ´Õ ¨Ñ¹·Ã¹ÔÀÒ¾§ÈÃѧÊÕÇÔ·ÂÒ15 PET/CT for Cancer in Head and Neck Region: Thyroid 103 and Nonthyroid Carcinoma ອ¨ÒÀÒ à¢ÕÂÇËÇÒ¹16 ¡ÒÃÃÑ¡ÉÒÁÐàÃç§ÈÕÃÉÐáÅÐÅíҤʹŒÇÂÃѧÊÕáÉÒ Ñ 113 ¨Ñ¹¨ÔÃÒ à¾ªÃÊØ¢ÈÔÃÔ17 ÀÒ¾¹íÒÇÔ¶Õ ÃѧÊÕáÉÒ¡ŒÒÇä¡Å Ñ 117 ¹Ñ¹·¡Ò¹µ àÍÕÂÁǹҹ¹·ªÑÂ, ¤íÒÁØ¡ ¤ÃͧÂØ·¸, ÊѨ¨Ò ã¨à¤Ã‹§ èÇÔÊÑ­­ÕÇÔ·ÂÒ18 Postoperative Pain Management in Pediatric Patients: What’s New? 125 What’s Recommendation? ÊØÇÃÃ³Õ ÊØÃàÈóÕǧȏ19 Outcome Improving in Neuroanesthesia: Neuro-interventional Perspective 131 ÍÑ­ªÅÕ ªÙâ蹏àǪÈÒʵÏ»‡Í§¡Ñ¹áÅÐÊѧ¤Á20 ¤ÇÒÁÊíҤѭ¢Í§ÂÒµŒÒ¹¾ÔÉ㹡ÒôÙáżٻÇÂÀÒÇоÔÉà©Õº¾Åѹ Œ † 135 ÊÑÁÁ¹ â©Á©ÒÂ
  21. 21. xxiàǪÈÒʵÏ¿„œ¹¿Ù21 ¡ÒÃÍÍ¡¡íÒÅѧËÅѧ¡Ò÷íÒËѵ¶¡ÒÃËÃ×ͼ‹ÒµÑ´ËÑÇ㨠143 ¡ÁŷԾ ËÒ­¼´Ø§¡Ô¨22 ¡ÒÃÍÍ¡¡íÒÅѧ¡ÒÂã¹âä¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ 155 ÇÔÅÒÇѳ ¶ÔÃÀѷþ§È23 ¡ÒÃÍÍ¡¡íÒÅѧ¡ÒÂã¹âäàºÒËÇÒ¹ 159 ÇÔÅÒÇѳ ¶ÔÃÀѷþ§È24 Íغµà˵ؤÍÊкѴ Ñ Ô 163 ÇÔÉ³Ø ¡ÑÁ·Ã·Ô¾Â25 Whiplash Injury: Myogenic Cause and Conservative Treatment 171 ¸ÕÃ´Ò ¾ÅÍÂྪÃÈÑÅÂÈÒʵÏ26 âä¢Í§·ÇÒÃ˹ѡáÅÐÅíÒäʌµÃ§·Õ¾ºº‹Í è 177 ÇÃÁÔ¹·Ã àËÃÕ­ÊØÇÃó27 Hepatocellular Carcinoma: Management in the New Era 183 ÊÁªÑ ÅÔÁÈÃÕ¨ÒàÃÔ­, §ÂØ·¸ ÈÔÃDz¹ÍÑ¡ÉÃ, ÊØ»ÃÕªÒ ÍÑÊÇ¡Ò­¨¹, ªØµÇªÂ âµÇÔ¡ÀÑ é í ÔÑ ÔÔ Ñ28 Exceeding 100 Liver Transplantations in Siriraj Hospital 189 §ÂØ·¸ ÈÔÃDz¹ÍÑ¡ÉÃ, ÊÁªÑ ÅÔÁÈÃÕ¨ÒàÃÔ­, »ÃÐÇѲ¹ â¦ÊÔµÐÁ§¤Å, »ÃÐàǪ ÁËÒÇÔ·µÇ§È, ÔÑ é í Ô ÊØ»ÃÕªÒ ÍÑÊÇ¡Ò­¨¹, ªØµÇªÂ âµÇÔ¡ÀÑ ÔÔ Ñ29 The .irst Live Donor Liver Transplantation in Thailand 193 §ÂØ·¸ ÈÔÃDz¹ÍÑ¡ÉÃ, ÊÁªÑ ÅÔÁÈÃÕ¨ÒàÃÔ­, »ÃÐÇѲ¹ â¦ÊÔµÐÁ§¤Å, »ÃÐàǪ ÁËÒÇÔ·µÇ§È, ÔÑ é í Ô ÊØ»ÃÕªÒ ÍÑÊÇ¡Ò­¨¹, ªØµÇªÂ âµÇÔ¡ÀÑ ÔÔ Ñ30 Robotic Surgery for General Surgeons: .uture or .antasy 197 ÇÔ·Ã ªÔ¹ÊNjҧÇѲ¹¡ØÅ, ¸ÇѪªÑ ÍѤÃÇÔ¾¸, ÍÑ°¾Ã µÃСÒÃʧ‹Ò, ÍÑÉ®Ò àÁ¸àÈÃÉ° Ù Ø ¸Ñ­à´ª ¹ÔÁÁÒ¹Çز¾§É, ³Ã§¤ àÅÔÈÍÃæÂÁ³Õ Ô31 Siriraj Trauma Center 203 »ÃÕªÒ ÈÔ÷ͧ¶ÒÇà Ô32 Siriraj Trauma Center 205 ÇÔÀÒÀó ÈÃÕ¾¨¹¸ÃÃÁ33 Journey to Excellent Burn Unit 211 ¾Ã¾ÃËÁ àÁ×ͧáÁ¹
  22. 22. xxiiÈÑÅÂÈÒʵÏÍÍÏ⸻´Ô¤Ê áÅСÒÂÀÒ¾ºíҺѴ34 Treatment of Pathologic .racture 219 ¨Ñ¹·¹ÃÑÈÁ ¨Ñ¹·¹Âԧ§, ¸ÕÃÇØ²Ô ¸ÃÃÁÇԺŏÈÃÕ, ÃоԹ·Ã ¾ÔÁÅÈÒ¹µÔ,ì ¡ŒÍ§à¢µ àËÃÕ­ÊØÇÃó è ÙÊÙµÈÒʵÏ-¹ÃÕàǪÇÔ·ÂÒ Ô35 Practical Management of Dysfunctional Uterine Bleeding 229 ¸Ñ¹ÂÒÃѵ¹ ǧȏǹҹØáɏ, ÊØªÒ´Ò ÍÔ¹·ÇÔDz¹, Á³Õ Ãѵ¹äªÂÒ¹¹· Ñ Ñâʵ ¹ÒÊÔ¡ ÅÒÃÔ§«Ç·ÂÒ Ô36 䫹ÑÊÍÑ¡àʺ áÅÐÃÔ´Êմǧ¨ÁÙ¡ 241 »ÒÃÂÐ ÍÒȹÐàʹ, ¾§È¡Ã µÑ¹µÔÅ»¡Ã, ͹ѭ­ ྱdzԪ, ਵ¹ ÅíÒÂͧàʶÕÂÃ Õ 37 ¡ÒÃ䴌¹º¡¾Ã‹Í§ã¹à´ç¡â´ÂÀÒ¾ÃÇÁáÅСÒäѴ¡Ãͧ¡ÒÃ䴌¹ã¹à´ç¡ááà¡Ô´ Ô Ô 259 ¡Ñ­­·Í§ ·Í§ãË­‹38 ¡ÒÃÊÙ­àÊÕ¡ÒÃ䴌¹¨Ò¡¡ÒùíÒàÊÕ§àÊ×ÍÁã¹¼Ù»ÇÂà´ç¡ Ô è Œ † 265 ÍÒªÇÔ¹·Ã µÑ¹ä¾¨ÔµÃ39 ¡ÒÃÊÙ­àÊÕ¡ÒÃ䴌¹㹼ٻÇÂà´ç¡¨Ò¡ÊÒà˵طҧ¾Ñ¹¸Ø¡ÃÃÁ Ô Œ † 271 ¹Ô¸ÇªÃ ÇѲ¹ÇÔ¨Òó ÔÑ40 ÊÒÂàÊÕ§໚¹ÍÑÁ¾Òµ 281 ©Ñ¹·ÔªÒ ⪵ԡdzԪ41 Hoarseness and Management 285 ¨ÕÃÐÊØ¢ ¨§¡ÅÇѲ¹ÒÍÒÂØÃÈÒʵÏ42 ¡Òû‡Í§¡Ñ¹âäËÅÍ´àÅ×Í´ÊÁͧ·Ñ§¡‹Í¹áÅÐËÅѧ¡Òü‹ÒµÑ´ é 289 ʧ¤ÃÒÁ ⪵ԡ͹تµ, §ªÑ ¹ÔÅй¹·, ¹ÒÃҾà »ÃÐÂÙÃÇÔDz¹, ¹Ô¾¹¸ ¾Ç§ÇÃÔ¹·Ã Ô Ñ43 Scrub Typhus in Thailand 297 Âؾ¹ Èؾ·¸Á§¤Å Ô Ø44 Molecular Epidemiology of Scrub Typhus in Thailand 301 »¯ÔÁҾà ǧɏ¾ÃËÁ¾Ô·¡É Ñ45 Recent Advances in the Diagnosis of Scrub Typhus 305 Wei Mei Ching
  23. 23. xxiii46 Iron Chelation: New Hope 313 ª®Ò ¾ÔÈÒž§È47 Deferasirox ÂҢѺàËÅ硪¹Ô´ÃѺ»Ãзҹ 317 ¹¾´Å ÈÔø¹ÒÃѵ¹¡ØÅ Ô ËÑÇ¢ŒÍàÃ×èͧÊËÊÒ¢ÒÇÔªÒªÕ¾¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾áÅСÒû‡Í§¡Ñ¹âä48 ÂÒ¨Ò¡ÊÁعä¾Ã¡ÑºàǪÈÒʵÏàªÔ§»ÃШѡɏ 323 ³Ñª¡Ã ÅéÒàÅÔÈ¡Ô¨, »ÃÐÇԷ ÍѤÃàÊÃÕ¹¹·, »ÃÐʾ¾Ã ¾Ñ¹¸à¾ç§, ·ÇÕ àÅÒ˾ѹ¸ í49 ËÅÑ¡¡ÒÃÊíҤѭ¢Í§¡ÒÃᾷἹä·Â 333 ·Ñ¾¾à·¾ ·Ô¾Âà¨ÃÔ­¸ÑÁ, Ãѵ´ÒÇÃó ·Ô¾Âà¨ÃÔ­¸ÑÁ, ·ÇÕ àÅÒ˾ѹ¸50 ¡ÒÃʋ§àÊÃÔÁÊØ¢ÀÒ¾´ŒÇ¸ÃÃÁÒ¹ÒÁÑ 341 ÊÔáҹµ ÀÙâ»Ã‹§, »ÃÐÁÇÅ ¤íÒᡌÇ, ·ÇÕ àÅÒ˾ѹ¸ Ô51 ¹Çѵ¡ÃÃÁ¡ÒþÂÒºÒÅ: ÇѲ¹¸ÃÃÁÊÌҧàÊÃÔÁÊØ¢ÀÒ¾·Õ§Â×¹ è Ñè 349 Çѹà¾ç­ ÀÔ­â­ÀÒÊ¡ØÅ52 Breast Cancer Prevention and Screening 351 Ê׺ǧȏ ¨Ø±ÒÀÔÊ·¸Ôì Ô53 Screening in Common Gynecologic Cancer: Ovarian Cancer Screening 355 »˜·ÁÒ àªÒǏ⾸Էͧ ì54 ¡Òû‡Í§¡Ñ¹ÀÒÇÐÊÁͧàÊ×ÍÁÃдѺ»°ÁÀÙÁÔ è 361 ÇÕÃÈÑ¡´Ôì àÁ×ͧä¾ÈÒÅ¡ÒôÙáżٌÊÙ§ÍÒÂØ55 Harmonized Care for Older Patients: .ocus on Hospitalized Patients 367 Ãا¹Ôù´Ã »ÃдÔÉ°ÊØÇÃó ‹ Ñ56 Harmonized Care for Older Patients: .ocus on Cognition 375 ÇÃÒÅѡɳ ÈÃÕ¹¹·»ÃÐàÊÃÔ°57 Harmonized Care for Older Patients: .ocus on Mobility 387 ÇÔäÅ ¤Ø»µ¹ÃµÈ¡ØÅ ÔÑ Ô Ñ
  24. 24. xxivÊÔè§áǴŌÍÁáÅÐÊØ¢ÀÒ¾58 Health Impacts of Environmental Threats in Thailand: 397 Epidemiological Aspects ÊÁà¡ÕÂÃµÔ ÈÔÃõ¹¾Ä¡É ÔÑ59 ¡ÒÃÈÖ¡ÉҼšÃзºµ‹ÍÊØ¢ÀÒ¾»ÃЪҪ¹·ÕèÍÒÈÑÂÍÂًÃͺ¹Ô¤ÁÍصÊÒË¡ÃÃÁÁÒºµÒ¾Ø´ 401 ¹ÔµÂÒ ÇѨ¹ÐÀÙÁ.Ô ¹Ñ¹·ÇÃó ÇÔ¨µÃÇÒ·¡ÒÃ, »ÃÒ³Õ ªÒ­³Ã§¤ Ô60 Climate Change and Allergic Disease 405 ÇÃÇÔª­ àËÅ×ͧàǪ¡ÒÃ, »ÒÃÂÐ ÍÒȹÐàʹ, µ‹Í¾§É ·Í§§ÒÁCraniofacial Care61 ¡ÅàÁç´¡Ò÷íҧҹ໚¹·ÕÁ´ÙáżٻÇ¡ÐâËÅ¡ÈÕÃÉÐáÅÐãºË¹ŒÒ¼Ô´»¡µÔ Œ † 415 ÈÃÕ»ÃÐÊÔ·¸Ôì ºØ­ÇÔÊ·¸Ô,ì ÈÃÕÇÁÅ Áâ¹àªÕÂǾԹ¨, ÇÃó´Õ ¾ÅÒ¹ØÀÒ¾ Ø Ô è ÔMovement Disorders62 Movement Disorder Surgery 433 ÈÃѳ ¹Ñ¹·ÍÒÃÕ, ºÃþµ ÊÔ·¸Ô¹ÒÁÊØÇÃó, ÍѤ¤¾§É ¹ÔµÊ§Ë, ¡¹¡ÇÃó ºØ­­¾ÔÊ®°‚, ÔÔ Ô ÍÀÔªÒµÔ ¾ÔÈÒž§ÈTraumatic Brain Injury63 Neurosurgical Perspective of Mild Traumatic Brain Injury 441 ºÃþµ ÊÔ·¸Ô¹ÒÁÊØÇÃó, »ÃШѡÉì ÈÃÕþվ²¹ì Ñ64 Neuropsychiatric Disorders after Mild Traumatic Brain Injury 453 ¾Ã¨ÔÃÒ »ÃÔǪÃÒ¡ØÅ Ñ¡ÒúҴà¨çº¢Í§ËÅÍ´àÅ×Í´65 ÀÒ¾ÃѧÊÕǹ¨©ÑÂÃкº»ÃÐÊÒ·ã¹¼Ù»ÇÂÍغµàËµØ Ô Ô Œ † Ñ Ô 459 ÊÔÃÍà µÃÔµÃСÒà Ô66 ÀÒ¾ÇÔ¹¨©ÑÂ㹼ٻǷÕ䴌úºÒ´à¨çººÃÔàdzËÅÍ´àÅ×Í´á´§¨Ò¡ÍغµàËµØ Ô Œ † è Ñ Ñ Ô 469 ¨ÔµÃÅÑ´´Ò ÇÐÈÔ¹Ãѵ¹67 Imaging of Trauma: Abdominal Trauma 479 ÇÃóÇÃÒ§¤ ÊØ·¸Ô¤ÃÕ Õ
  25. 25. xxv68 Traumatic Cerebrovascular Injury: Neurosurgical Perspective 489 àÍ¡ÇØ²Ô ¨Ñ¹á¡ŒÇ, ·ÇÕÈ¡´Ôì àÍ×ͺح­ÒÇѲ¹, ÍÑ­ªÅÕ ªÙâ蹏 Ñ é69 Interventional Radiology Management in Traumatic Patient 497 (Body and Peripheral Artery) ÊÁÃÒª ¸ÃÃÁ¸ÃÇѲ¹ÀÒÇмԴ»¡µÔ¢Í§¡Òù͹ËÅѺ70 ¹Í¹¡Ã¹áÅÐÀÒÇÐËÒÂ㨼Դ»¡µÔ¢³ÐËÅѺª¹Ô´ÍØ´¡Ñ¹ é 505 ÇÔª­ ºÃóËÔí Ñ71 Narcolepsy 523 ÇѲ¹ªÑ ⪵ԹÂÇѵáØÅ Ñ72 Surgical Treatment for Sleep Disordered Breathing 529 ÇÔª­ ºÃóËÔí ÑÀÒÇмԴ»¡µÔ¢Í§¡ÒáÅ×¹73 Management for Dysphagia Patients 535 ⪤ªÑ àÁ¸ÕäµÃÃѵ¹, ๵ÃÒ ºÑÇ¡¹¡, ÀÒÇÔ¹ à¡É¡ØÅ, ÇÃصÁ ¾§ÈÒ¾Ôª­, Êع¹· ͧÍÒ¨ ÑÀÒÇÐàÅ×Í´ÍÍ¡ã¹·Ò§à´Ô¹ÍÒËÒÃʋǹº¹74 ÀÒÇÐàÅ×Í´ÍÍ¡ã¹·Ò§à´Ô¹ÍÒËÒÃʋǹº¹ 543 ÇÃÒÂØ »ÃѪ­¡ØÅ75 Management of Esophageal Varices and Esophageal Variceal Hemorrhage 555 ÈÔÇоà äªÂ¹Øǵ,Ô ¹¹·ÅÕ à¼‹ÒÊÇÑÊ´Ô,ì Êؾ¨¹ ¹ÔÁ͹§¤ Ñ è76 Embolization for Upper Gastrointestinal Hemorrhage 565 ÇÅÑÂÅѡɳ ªÑÂÊٵà ¡ÒÃÇÔ¨ÑÂáÅÐÇÔ·ÂÒÈÒʵϾ×é¹°Ò¹·Ò§¡ÒÃᾷ77 General Aspects of Tumor Microenvironment 569 »‚µÔ ¸ØǨԵµ78 Cancer-associated .ibroblasts in Tumor Progression 573 ª¹ÔµÃÒ ¸ØǨԵµ
  26. 26. xxvi79 Digital Image Processing and Data Management for Clinical 579 Registry and Clinical Research »ÃоѲ¹ ÊØüŠÔ80 Research and Road to Innovation and Business 587 ÇÃóРÁËÒ¡ÔµµÔ¤³, ¾ÔÁ¾»ÃÐä¾ ¸ÕÃЪվ, ¸ÒÃÔ¹ àÍÕÂÁྪÃÒ¾§È, ¸¹¾Å ÇÕÃÒÊÒ Ø è ¡¯ËÁÒ·ҧ¡ÒÃᾷ81 Transplantation: Medico-legal Investigation 595 »ÃÕªÒ ÈÔ÷ͧ¶ÒÇà Ô82 ¤ÇÒÁ¼Ô´»¡µÔ¢Í§ÊÒÂàÊÕ§ 597 侺Ùŏ ÊØþ§É Õ 83 Hearing Loss in Children: 120 year Evolution in Management 601 ÊØǨ¹Ò ͸ÔÀÒÊ Ñ ´Ñª¹Õ ´Ñª¹Õ 605
  27. 27. àǪÈÒʵÏ·¹Âؤ 2553 Ñ º··Õè 1 1 Childhood Seizure and Epilepsy ÍÒ¨ÒÏ ¹ÒÂᾷÊÃÇÔÈ ÇÕÃÇÃó ÀÒ¤ÇÔªÒ¡ØÁÒÃàǪÈÒʵÏ ¤³Ðá¾·ÂÈÒʵÏÈÔÃÔÃÒª¾ÂÒºÒÅ ÁËÒÇÔ·ÂÒÅÑÂÁËÔ´Å ÍÒ¡Òêѡ (seizure) ໚¹Ë¹Öè§ã¹ÍÒ¡Ò÷ҧÃкº»ÃÐÊÒ··Õ辺䴌º‹ÍÂã¹àǪ»¯ÔºÑµÔ·ÑèÇä»â´ÂʋǹãË­‹¢Í§¼Ù»Ç¡ÅØÁ¹Õ¨ÐÁÕ»ÃÐÇѵ¡ÒÃà¤Å×͹äËǢͧËҧ¡Ò·ռ´»¡µÔઋ¹ à¡Ãç§ ËÃ×Í à¡Ãç§ Œ † ‹ é Ô è è Ô¡Ãеء·Ñ駵ÑÇ ¼ÙŒ»†ÇºҧÃÒÂÍÒ¨ÁÕᤋÍÒ¡ÒÃàËÁ‹ÍÅÍ ¤ÇÒÁÃٌÊÖ¡µÑÇŴŧ ËÃ×ÍÁÕÍÒ¡ÒäŌÒÂÊд،§ÍÒ¡Òôѧ¡Å‹ÒÇÍҨ໚¹ÍÒ¡ÒêѡËÃ×ÍäÁ‹ãª‹¡ä´Œ ´Ñ§¹Ñ¹¡ÒÃãˌ¡ÒÃÇÔ¹¨©Ñ¼ٻÇ¡ÅØÁ¹ÕᾷµÍ§ÍÒÈÑ ç é Ô Œ † ‹ é Œ¡Òëѡ»ÃÐÇѵԷÕè´Õà¾×èÍá¡NjÒ໚¹ÍÒ¡ÒêѡËÃ×ÍäÁ‹ áÅжŒÒ㪋໚¹ÍÒ¡Òêѡª¹Ô´ã´ ʋǹ¡ÒõÃǨËҧ¡ÒÂáÅСÒÃʋ§µÃǨ·Ò§ËŒÍ§»¯ÔºÑµÔ¡Ò÷Õè¨íÒ໚¹àª‹¹ ¡ÒõÃǨ¤Å×è¹ä¿¿‡ÒÊÁͧËÃ×Í ¡ÒõÃǨÀÒ¾¶‹Ò¤Å×¹áÁ‹àËÅç¡ä¿¿‡ÒÊÁͧ¨Ðª‹ÇÂʹѺʹع㹡ÒÃÇÔ¹¨©ÑÂâä ËÒÊÒà˵آͧÍÒ¡Òêѡ áÅÐ è Ôãˌ¡ÒÃÃÑ¡ÉÒ·ÕàËÁÒÐÊÁ è ÊÒà˵آͧÍÒ¡Òêѡ¹Ñ¹ÁÕ䴌ËÅÒÂÍ‹ҧ ÍÒ¨à¡Ô´¨Ò¡âä¢Í§ÊÁͧàͧઋ¹ âäËÅÍ´àÅ×Í´ÊÁͧ éÁÐàÃç§ã¹ÊÁͧ ËÃ×ÍâäÅÁªÑ¡ (epilepsy) ¹Í¡¨Ò¡¹Õ§ÁÕâä·Ò§Ã‹Ò§¡ÒÂÍ×¹æ ÍÕ¡«Ö§Áռŵ‹ÍÊÁͧáÅÐ é Ñ è è·íÒãˌà¡Ô´ÍÒ¡Òêѡ䴌 «Ö§¡ÒÃÃÑ¡ÉÒ¨Ðᵡµ‹Ò§¡Ñ¹ä»ã¹áµ‹ÅÐâä ´Ñ§¹Ñ¹á¾·Â¨§¤ÇÃÁÕ¤ÇÒÁÃٌ ¤ÇÒÁ è é ÖࢌÒ㨶֧á¹Ç·Ò§ã¹¡ÒôÙáÅÃÑ¡ÉҼٻǷÕÁÍÒ¡ÒùÕ໚¹Í‹ҧ´Õ Œ † è Õ é¤íÒ¨íÒ¡Ñ´¤ÇÒÁ ÍÒ¡Òêѡ (seizure) ໚¹ÍÒ¡Òâͧ¼Ù»Ç·ÕÁ¼ÅÁÒ¨Ò¡¡ÃÐáÊä¿¿‡Ò¢Í§à«ÅŏÊÁͧ·Õ·Ò§Ò¹ Œ † è Õ è íÁÒ¡¼Ô´»¡µÔ (excessive neuronal electrical discharge) ·íÒãˌà¡Ô´¤ÇÒÁà»ÅÕ¹á»Å§·Ò§Ã‹Ò§¡Ò è¢Í§¼Ù»Ç ÍÒ¡ÒÃáÊ´§·Ò§Ã‹Ò§¡Ò¹ѹÁÕ䴌ËÅÒÂÍ‹ҧઋ¹ ÍÒ¡Òêѡ à¡Ãç§ ¡Ãеء (motor seizure) Œ † é¡ÒÃà»ÅÕè¹á»Å§·Ò§¤ÇÒÁÃٌÊÖ¡ (sensory seizure) ¤ÇÒÁ¼Ô´»¡µÔ·Ò§ÍÒÃÁ³ (psychic seizure)໚¹µŒ¹ ÍÒ¡Òêѡ ẋ§à»š¹ 2 ¡ÅØÁãË­‹æ ´Ñ§¹Õé ‹ 1. Provoked seizure ËÃ×Í symptomatic seizure ËÁÒ¶֧ ÍÒ¡Òêѡ·Õà¡Ô´¢Ö¹â´ÂÁÕ»¨¨Ñ è é ˜Í×¹ÁÒ¡Ãеعઋ¹¡Òêѡ·ÕÁÊÒà˵ØÁÒ¨Ò¡âä·Ò§¡ÒÂËÃ×Í ¤ÇÒÁ¼Ô´»¡µÔ·Ò§ÊÁͧ·Õà¡Ô´¢Ö¹ã¹¢³Ð¹Ñ¹ è Œ è Õ è é éáÅÐàÁ×Í»˜¨¨ÑÂËÃ×ÍâäàËŋҹÕËÒ ÍÒ¡Òêѡ¡ç¨ÐËÒÂä»àª‹¹¡Ñ¹ ÊÒà˵آͧÍÒ¡Òêѡ㹡ÅØÁ¹ÕÁÁÒ¡ÁÒ è é ‹ é մѧáÊ´§änj㹵ÒÃÒ§·Õè 1 2. Unprovoked seizure ËÁÒ¶֧ ÍÒ¡Òêѡ·Õà¡Ô´¢Ö¹â´Â·ÕäÁ‹Á»¨¨ÑÂÍ×¹ÁÒ¡Ãеع è é è Õ ˜ è Œ
  28. 28. 2 Childhood Seizure and EpilepsyµÒÃÒ§·Õè 1 ÊÒà˵آͧ symptomatic seizure ·Õ辺º‹Í ! Cerebrovascular disease: Thrombosis, embolism, hemorrhage, vasculitis ! Central nervous system infection: Meningitis, encephalitis, brain abscess ! Hypoxic-ischemic encephalopathy ! Brain tumor ! Hypotensive/Hypertensive encephalopathy ! Metabolic: hypoglycemia, hypo/hypernatremia, hypocalcemia, hypomagnesemia ! Head injury ! Congenital brain malformation ! Drug / drug withdrawal ! Inborn errors of metabolism ! Degenerative brain disease ! .ebrile seizure ã¹¼Ù»ÇÂà´ç¡¹Ñ¹ ÍÒ¨ÁÕÍÒ¡ÒÃÍ×¹æ·Õà¡Ô´¢Ö¹ªÑÇ¢³Ð (paroxysmal events) ·ÕÁšɳкҧÍ‹ҧ Œ † é è è é è è ÕѤŌÒ¡ѺÍÒ¡Òêѡ ·íÒãˌÍÒ¨ÊѺʹ¡ÑºÍÒ¡Òêѡ䴌 â´Âᵡµ‹Ò§¡Ñ¹ä»µÒÁᵋÅЪ‹Ç§ÍÒÂØ (1) ´Ñ§áÊ´§änj㹵ÒÃÒ§·Õè 2µÒÃÒ§·Õè 2 Paroxysmal non-epileptic events ã¹à´ç¡·Õ¾ºº‹ÍÂᡵÒÁª‹Ç§ÍÒÂØ èNeonates Infants Children and adolescentsSleep myoclonus Apnea Breath-holding spell, Syncope,Hyperexplexia Jitteriness Sandifer, Day dreaming Sleep myoclonus Abnormal movement eg. Chorea, Tics Benign paroxysmal torticolis Benign paroxysmal vertigo Spasmus nutans Hyperventilation syndrome Opsoclonus Psychologic disorder Night mare / night terror NarcolepsyËÁÒÂà赯 ´´á»Å§¨Ò¡àÍ¡ÊÒÃËÁÒÂàÅ¢ 1 Ñ âäÅÁªÑ¡ (epilepsy) ¤×Íâä·Õ¼»ÇÂÁÕÍÒ¡Òêѡâ´ÂäÁ‹Á»¨¨Ñ¡Ãеع (unprovoked seizure) è ٌ † Õ ˜ ŒÁÒ¡¡Ç‹Ò 2 ¤Ãѧ¢Ö¹ä» é é
  29. 29. àǪÈÒʵÏ·¹Âؤ 2553 Ñ 3 âäÅÁªÑ¡ÁÕÊÒà˵ØáÅоÂÒ¸Ô¡Òà¹Ô´ä´ŒËÅÒÂÍ‹ҧ ã¹·Õ¹¢Íẋ§µÒÁÊÒà˵Ø䴌´§¹Õé (2) í è Õé Ñ 1. Idiopathic: âäÅÁªÑ¡¹ÕäÁ‹ä´Œà¡Ô´¨Ò¡¾ÂÒ¸ÔÊÀÒ¾ã¹ÊÁͧᵋÁÊÒà˵Øà¹×ͧ¨Ò¡¾Ñ¹¸Ø¡ÃÃÁ é Õ è 2. Symptomatic epilepsy: âäÅÁªÑ¡·ÕÁÊÒà˵ØÁÒ¨Ò¡¡Ò÷ÕÁ¾ÂÒ¸ÔÊÀÒ¾¢Í§ÊÁͧ«Ö§ÍÒ¨ è Õ è Õ è໚¹¾ÂÒ¸ÔÊÀÒ¾·Õà¡Ô´¢Ö¹ÁÒ¹Ò¹ áÅÐäÁ‹Á¡ÒÃà»ÅÕ¹á»Å§ ઋ¹ cortical dysplasia, congenital brain è é Õ èanomaly, á¼Å໚¹¨Ò¡¡Ò÷Õà¤Â໚¹âäÊÁͧÍÑ¡àʺ (encephalitis), à¤ÂÁÕàÅ×Í´ÍÍ¡ã¹ÊÁͧáÅÐ䴌 èÃѺ¡Òü‹ÒµÑ´, à¤ÂÁÕ»ÃÐÇѵ¢Í§ÊÁͧ¢Ò´ÍÍ¡«Ôਹ (birth asphyxia) ËÃ×ÍÍÒ¨¨ÐÁÕÊÒà˵بҡ¡Ò÷Õà¹×Í Ô è éÊÁͧ¶Ù¡·íÒÅÒ¨ҡâä metabolic ËÃ×Í degenerative brain disorder 3. Cryptogenic âäÅÁªÑ¡·Õ¤Ò´Ç‹Ò¹‹Ò¨ÐÁÕÊÒà˵بҡҡ÷ÕÁ¾ÂÒ¸ÔÊÀÒ¾¢Í§ÊÁͧ ᵋ¡Òà è è Õʋ§µÃǨ·Ò§ËŒÍ§»¯Ôºµ¡ÒÃã¹»˜¨¨Øº¹ÂѧäÁ‹ÊÒÁÒöµÃǨ¾ºä´Œ Ñ Ô Ñ â´ÂÊÃØ» ÍÒ¡ÒêѡáÅÐâäÅÁªÑ¡¹Ñ¹áµ¡µ‹Ò§¡Ñ¹ â´ÂÁÕá¹Ç·Ò§¡ÒÃÇÔ¹¨©Ñ´ѧἹÀÙÁ·Õè 1 é Ô Ô á¼¹ÀÙÁÔ·Õè 1 á¹Ç·Ò§¡ÒÃÇÔ¹Ô¨©ÑÂÍÒ¡ÒêѡáÅÐâäÅÁªÑ¡¡ÒÃẋ§»ÃÐàÀ·¢Í§ÍÒ¡Òêѡ (Seizure classification) ¡ÒÃẋ§»ÃÐàÀ·¢Í§ÍÒ¡Òêѡ·ÕÂÍÁÃѺáÅÐ㪌¡¹á¾Ã‹ËÅÒ·ÕÊ´¤×Í¡ÒÃẋ§µÒÁ International è Ñ èØLeague Against Epilepsy (ILAE) ã¹»‚ ¤.È. 1981 â´ÂÍÒÈÑÂÅѡɳÐÍÒ¡Òêѡ (clinical seizure (3)description) áÅСÒÃà»ÅÕ¹á»Å§¢Í§¤Å׹俿‡ÒÊÁͧ (electroencephalography, EEG) ໚¹ËÅÑ¡ã¹ è è¡ÒÃẋ§ «Ö§áº‹§»ÃÐàÀ·¢Í§ÍÒ¡Òêѡ䴌 3 »ÃÐàÀ· ¤×Í partial seizure, generalized seizure áÅÐ èunclassified seizure
  30. 30. 4 Childhood Seizure and Epilepsy Partial seizure (.ocal seizure) (4) Partial ËÃ×Í focal seizure ໚¹ÍÒ¡Òêѡ«Ö§à¡Ô´¨Ò¡¡Ò÷ÕÁ¡ÃÐáÊä¿¿‡Ò·ÕÁÒ¡¼Ô´»¡µÔà¡Ô´¢Ö¹ è è Õ è é¨Ò¡ÊÁͧʋǹã´Ê‹Ç¹Ë¹Ö§ â´Â¡ÃÐáÊä¿¿‡Ò´Ñ§¡Å‹ÒÇÍÒ¨¤§ÍÂÙ·à´ÔÁËÃ×Í ÍÒ¨à¤Å×͹价ÕÊÁͧʋǹÍ׹䴌 è ‹ Õè è è è«Ö§¨ÐÁռŵ‹ÍÅѡɳСÒêѡ¢Í§¼Ù»Ç ÍÒ¡ÒêѡẺ¹Õẋ§ä´ŒÍ¡à»š¹ 2 ª¹Ô´Â‹Í¤×Í è Œ † é Õ 1. Simple partial seizure (SPS) ã¹¢³ÐªÑ¡¼Ù»Ç¨ÐÂѧÃÙÊ¡µÑÇ (consciousness) ·Õ´ÍÂً Œ † ŒÖ è ÕÅѡɳСÒêѡ¢Í§¼ÙŒ»†Ç¹Ñ鹨ТÖé¹ÍÂً¡ÑºÇ‹ÒÊÁͧʋǹ㴶١¡Ãе،¹â´Â¡ÃÐáÊä¿¿‡Ò·Õè¼Ô´»¡µÔ¼Ù»ÇÂÍÒ¨¨ÐÁÕÍÒ¡ÒÃà¤Å×͹äËǢͧËҧ¡Ò·ռ´»¡µÔ (motor seizure) ઋ¹ à¡Ãç§ ¡Ãеء ʋǹ˹֧ Œ † è è Ô èʋǹ㴢ͧËҧ¡Ò ઋ¹ãºË¹ŒÒ äËŋ ᢹ Á×Í ¢ÒËÃ×Íà·ŒÒ ¢ŒÒ§ã´¢ŒÒ§Ë¹Ö§ ºÒ§ÃÒÂÍÒ¨¨ÐÁÕÍÒ¡Ò÷ҧ è¤ÇÒÁÃÙÊ¡ËÃ×Í »ÃÐÊÒ·ÊÑÁ¼ÑʾÔàÈÉÍ×¹æ (somatosensory or special-sensory seizure) ઋ¹ ªÒᢹ ŒÖ è¢Ò¢ŒÒ§ã´¢ŒÒ§Ë¹Ö§ àËç¹áʧ 䴌¹àÊÕ§ ËÃ×Í䴌¡ÅÔ¹µ‹Ò§æ ·Õ¼´»¡µÔ è Ô è è Ô 2. Complex partial seizure (CPS) ¼ÙŒ»†Ç¨ÐÁÕ impairment of consciousness «Öè§consciousness ·Õ㪌¡¹ã¹âäÅÁªÑ¡¹Ñ¹»ÃСͺ´ŒÇ 2 ʋǹ¤×Í responsiveness (¡Òõͺʹͧµ‹Í è Ñ éÊÔ§àÃŒÒ ËÃ×Í·íÒµÒÁ¤íÒÊѧÍ‹ҧÁÕ¤ÇÒÁËÁÒÂ) áÅÐ awareness (¡ÒÃÃѺÃÙáÅÐÊÒÁÒö¨´¨íÒà˵ءÒó è è Œµ‹Ò§æ ·Õèà¡Ô´¢Öé¹ã¹¢³Ð·ÕèÁÕÍÒ¡Òêѡ) ¼ÙŒ·Õ辺àË繡Òêѡ¢Í§¼ÙŒ»†ÇÂÍÒ¨¨Ð͸ԺÒÂNjҼٌ»†ÇÂÁÕÍÒ¡ÒÃàËÁèÍ à»ç¹ÅÁ ËÁ´ÊµÔ ËÃ×ͺҧ¤ÃѧÍÒ¨¨Ð´ÙàËÁ×͹ÃÙÊ¡µÑÇ´ÕáµèäÁè·ÓµÒÁ¤ÓÊѧ ã¹¢³Ð·Õª¡¹Ñ¹ ¼Ù»ÇÂ- é éÖ è è Ñ é é èºÒ§ÃÒÂÍÒ¨¨ÐÁÕ¡ÒÃà¤Å×è͹äËǢͧËҧ¡Ò«éíÒæ àÃÕÂ¡Ç‹Ò automatism «Ö觼ٌ»†ÇÂÍÒ¨¨Ð¢ÂѺ»Ò¡àËÁ×͹à¤ÕÂÇ ËÃ×Í¡Å×¹ (lips smacking, swallowing) ¨ÑºÁ×ÍËÃ×ÍËÂÔº¨ÑºÊÔ§¢Í§µ‹Ò§æ ËÃ×Íà´Ô¹ä»ÁÒ é è«Ö§à»š¹¾ÄµÔ¡ÃÃÁ·ÕäÁ‹Á¤ÇÒÁËÁÒ â´Â·ÑÇä»ÃÐÂÐàÇÅÒ·Õª¡»ÃÐÁÒ³ 2-3 ¹Ò·Õ (30 ÇÔ¹Ò·Õ – 10 ¹Ò·Õ) è è Õ è è ѹ͡¨Ò¡¹ÕÍÒ¨¾ºÍÒ¡ÒùíÒ pre-ictal symptom (aura) «Ö§à»š¹¤ÇÒÁÃÙÊ¡·Õ¼»Çºҧ¤¹ÍÒ¨¨Ð͸ԺÒ é è Œ Ö è ٌ †ä´Œ¡Í¹ÁÕÍÒ¡Òêѡ ´Ñ§·Õ¾ºã¹ SPS ËÅѧ¨Ò¡ªÑ¡ (post-ictal state) ¼Ù»ÇÂÁÑ¡¨ÐÁÕÍÒ¡ÒÃÊѺʹ䴌µÍ ‹ è Œ † ‹à»š¹¹Ò·Õ ¼ÙŒ»†Ç·ÕèàÃÔèÁµŒ¹¡Òêѡ´ŒÇ SPS ËÃ×Í CPS ¹Ñé¹ÍÒ¨¨ÐÁÕ¡ÒÃà¡Ãç§ËÃ×Í¡Ãеء¢Í§Ã‹Ò§¡Ò·ѧµÑǵÒÁÁÒ ¨ÐàÃÕÂ¡Ç‹Ò partial seizure evolving to secondarily generalized seizure ´Ñ§¹Ñ¹¼Ù»Ç·Õè é é Œ †ÁÕ¼¾ºÇ‹ÒÁÕÍÒ¡ÒÃà¡Ã秡Ãеء·Ñ§µÑǹѹÍÒ¨¨Ð໚¹¡ÒêѡẺ focal ¹íÒÁÒ¡‹Í¹¡ç䴌 ٌ é é Generalized seizure (4) Generalized seizure ໚¹ÍÒ¡Òêѡ·Õà¡Ô´¢Ö¹¨Ò¡¡ÒÃà»ÅÕ¹á»Å§¢Í§¡ÃÐáÊä¿¿‡Ò·Õè¡Ãеع è é è ŒÊÁͧ·ÑèÇæ仾ÌÍÁ¡Ñ¹·Ñé§Êͧ¢ŒÒ§ ·íÒãˌÁռŵ‹Í¤ÇÒÁÃٌÊÖ¡µÑÇáÅÐ ¡ÒÃà¤Å×è͹äËǢͧ¡ÅŒÒÁà¹×éÍ·ÕäÁ‹¨Òà¾Òзբҧ㴢ŒÒ§Ë¹Ö§¢Í§Ã‹Ò§¡Ò generalized seizure ẋ§Í͡໚¹ 4 ¡ÅØÁãË­‹æ 䴌ᡋ è í è Œ è ‹ 1. Tonic-clonic seizure (grand mal) ¼Ù»Ç¨ÐÁÕ¤ÇÒÁÃÙÊ¡µÑÇ·ÕŴŧ ËÇÁ¡ÑºÍÒ¡ÒÃà¡Ãç§ áÅÐ/ Œ † ŒÖ èËÃ×Í¡Ãеء¢Í§ÅíÒµÑÇ, ᢹ¢Ò â´Â·ÑèÇä»ÍÒ¡Òêѡ¨ÐàÃÔèÁµŒ¹´ŒÇÂÍÒ¡ÒÃà¡Ãç§ (tonic phase) áŌǵÒÁÁÒ´ŒÇÂÍÒ¡ÒáÃеء (clonic phase) ª‹Ç§·ÕèÁÕÍÒ¡Òêѡ¼ÙŒ»†ÇÂÍÒ¨ÁÕÍÒ¡Ò÷ҧÃкº»ÃÐÊÒ·Íѵâ¹ÁѵÃÇÁ´ŒÇ¤×Í ÁÕÁÒ¹µÒ¢ÂÒÂ, ¹éÒÅÒ¿ÙÁ»Ò¡, à˧×ÍÍÍ¡, »˜ÊÊÒÇÐ Íب¨ÒÃÐÃÒ´ ËÅѧ¨Ò¡ªÑ¡ ԋ ‹ í è¼Ù»ÇÂÁÑ¡¨ÐÁÕÍÒ¡ÒÃà¾ÅÕ ÊѺʹ ËÅÑºä» ÍÒ¡Òêѡª¹Ô´¹Õé ¼Ù¤¹·ÑÇä»ÁÑ¡ÃÙ¨¡ã¹ª×Í ÅÁºŒÒËÁÙ ¼Ù»Ç Œ † Œ è ŒÑ è Œ †

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