·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
                            ”À√—∫·æ∑¬å
    (Clinical Practice Guidelines for Hemorrhagic Stroke)



                                  ‚¥¬




                   √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
                  √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬
                    ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬
                  ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬
                       ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉∑¬
          ”π—°æ—≤π“«‘™“°“√·æ∑¬å °√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢
            ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢




                                              ©∫—∫∑’Ë 1 æ.». 2547 (æ‘¡æå§√—Èß∑’Ë 1)
†                                             ISBN : 974-422-093-7
·π«∑“߇«™ªØ‘∫µπ’È ‡ªìπ‡§√◊Õß¡◊Õ à߇ √‘¡§ÿ≥¿“æ¢Õß°“√∫√‘°“√¥â“π ÿ¢¿“æ∑’‡Ë À¡“– ¡
                    — ‘          Ë

°—∫∑√—欓°√·≈–‡ß◊Õπ‰¢ —ß§¡‰∑¬ ‚¥¬À«—ߺ≈„π°“√ √â“߇ √‘¡·≈–·°â‰¢ªí≠À“À“ ÿ¢¿“æ¢Õß
                 Ë

§π‰∑¬Õ¬à“ß¡’ª√– ‘∑∏‘¿“æ·≈–§ÿâ¡§à“ ¢âÕ·π–π”µà“ß Ê „π·π«∑“߇«™ªØ‘∫—µ‘π’ȉ¡à„™à¢âÕ§—∫

¢Õß°“√ªØ‘∫—µ‘ ºŸâ„™â “¡“√∂ªØ‘∫—µ‘·µ°µà“߉ª®“°¢âÕ·π–π”‰¥â „π°√≥’∑’Ë ∂“π°“√≥å·µ°µà“ß

ÕÕ°‰ªÀ√◊Õ¡’‡Àµÿº≈∑’ ¡§«√ ‚¥¬„™â«®“√≥≠“≥∑’‡Ë ªìπ∑’¬Õ¡√—∫„π —ß§¡
                   Ë            ‘                Ë




                            ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
§”π‘¬¡

            ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°‡ªìπ‚√§∑’Ëæ∫‰¥â∫àÕ¬ „πª√–‡∑»·∂∫‡Õ‡™’¬¡“°°«à“ª√–‡∑»∑“ßµ–«—πµ°
‚¥¬¡’Õÿ∫—µ‘°“√≥å Ÿß∂÷ß√âÕ¬≈– 25-35 ¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ´÷Ëß‚√§π’ȇªì𠓇Àµÿ°“√µ“¬·≈–§«“¡æ‘°“√
Õ—π¥—∫µâπÊ ‚¥¬‡©æ“–„πºŸâ ŸßÕ“¬ÿ ·≈–‡ªìπªí≠À“∑“ß°“√·æ∑¬å∑’Ë ”§—≠¢Õߪ√–‡∑» „πªí®®ÿ∫—πæ∫«à“¡’§«“¡
·µ°µà“ß„π¥â“π∫ÿ§≈“°√·≈–§«“¡æ√âÕ¡¢Õ߇§√◊ËÕß¡◊Õ∑“ß°“√·æ∑¬å∑’Ë¡’À≈“¬ª√–‡¿∑·≈–¡’°“√°√–®“¬∑’ˉ¡à
‡À¡“– ¡ ®÷ß∑”„Àâ„πª√–‡∑»‰∑¬¡’‡«™ªØ‘∫—µ‘∑’ˉ¡à‡À¡◊Õπ°—π∑—Èß„π¥â“π°“√«‘π‘®©—¬·≈–√—°…“‚√§À≈Õ¥‡≈◊Õ¥
 ¡Õß·µ°
             ∂“∫—πª√– “∑«‘∑¬“ „π∞“𖇪ìπ ∂“∫—π«‘™“°“√‡©æ“–∑“ߥâ“π√–∫∫ª√– “∑„π√–¥—∫ Ÿß°«à“µµ‘¬¿Ÿ¡‘
‰¥âµ√–Àπ—°∂÷ߪí≠À“¥—ß°≈à“«®÷߉¥â®¥∑”·π«∑“߇«™ªØ‘∫µ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° ”À√—∫·æ∑¬å„π√–¥—∫ª√–‡∑»
                                    —                —‘
‚¥¬√à«¡°—∫ºŸâ∑√ß§ÿ≥«ÿ≤‘·≈–ºŸâ‡™’ˬ«™“≠¥â“π‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°∑—Ë«ª√–‡∑» ‡æ◊ËÕÀ«—ß„À⇰‘¥ª√–‚¬™πå·°à
·æ∑¬åÕ¬à“ß·∑â®√‘ß„π°“√∑’Ë®–π”§«“¡√Ÿâ∑’ˉ¥â√—∫‰ªªØ‘∫—µ‘‰¥â∂Ÿ°µâÕß·≈–‡ªìπ¡“µ√∞“π‡¥’¬«°—π∑—Ë«ª√–‡∑» ‚¥¬¡’
°“√¥”‡π‘πß“π¥—ßπ’È
    1. «—π∑’Ë 16 °ÿ¡¿“æ—π∏å 2547 › 20 ‡¡…“¬π 2547 ª√–™ÿ¡§≥–∑”ß“πºŸ∑√ß§ÿ≥«ÿ≤·≈–ºŸ‡â ™’¬«™“≠ √«¡ 6 §√—ß
                                                                         â             ‘    Ë         È
    2. «—π∑’Ë 29 ‡¡…“¬π 2547 ®—¥ àß·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° (©∫—∫√à“ß) æ√âÕ¡·∫∫
        ª√–‡¡‘π„Àâ·æ∑¬å∑—Ë«ª√–‡∑»‚¥¬ºà“π∑“ß§≥–·æ∑¬»“ µ√å¢Õß¡À“«‘∑¬“≈—¬µà“ß Ê ‚√ßæ¬“∫“≈»Ÿπ¬å
        ‚√ßæ¬“∫“≈®—ßÀ«—¥ ·≈–  ”π—°ß“π “∏“√≥ ÿ¢®—ßÀ«—¥
    3. «—π∑’Ë 9 › 10  ‘ßÀ“§¡ 2547 ‡™‘≠·æ∑¬å®“°∑—«ª√–‡∑»‡¢â“√à«¡ª√–™ÿ¡/ —¡¡π“ ª√—∫ª√ÿß·π«∑“ßœ (©∫—∫√à“ß)
                                                 Ë
    4. «—π∑’Ë 24  ‘ßÀ“§¡ 2547 ª√–™ÿ¡§≥–∑”ß“πºŸ∑√ß§ÿ≥«ÿ≤·≈–ºŸ‡â ™’¬«™“≠‡æ◊Õæ‘®“√≥“ª√—∫ª√ÿß·π«∑“ß
                                                     â              ‘        Ë       Ë
        ‡«™ªØ‘∫µ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„Àâ¡§«“¡ ¡∫Ÿ√≥å ‡æ◊Õ®—¥æ‘¡æå§√—ß∑’Ë 1 ·≈–‡º¬·æ√àµÕ‰ª
                  —‘                           ’                Ë              È              à
            Õ¬à“߉√°Áµ“¡ ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°©∫—∫π’È ‡ªìπ§”·π–π”„π ‘Ëß∑’˧«√·°à
°“√ªØ‘∫µ‡‘ ∑à“π—π ∑—ßπ’„π°“√ªØ‘∫µ®√‘ߢ÷π°—∫¥ÿ≈¬æ‘π®¢Õß·æ∑¬åº¥·≈ºŸª«¬¢≥–π—π‡ªìπ ”§—≠
          —      È È È             —‘ È            ‘              Ÿâ Ÿ â É         È
            „π∑⓬∑’Ë ÿ¥π’È ∂“∫—πª√– “∑«‘∑¬“À«—߇ªìπÕ¬à“߬‘Ëß«à“ ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
©∫—∫π’®°‡°‘¥ª√–‚¬™πå ”À√—∫·æ∑¬å∑®–𔉪ª√–¬ÿ°µå„™âÕ¬à“ß°«â“ߢ«“ß ‡æ◊Õ„Àâª√–™“™π™“«‰∑¬¡’§≥¿“æ
       È—                             ’Ë                                         Ë                ÿ
™’«µ∑’¥’ ·≈–„§√à¢Õ¢Õ∫§ÿ≥ √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬ √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬
   ‘ Ë
 ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬  ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥
 ¡Õ߉∑¬ §≥–·æ∑¬»“ µ√宓°¡À“«‘∑¬“≈—¬µà“ß Ê ∑’‰¥â„Àâ§«“¡√à«¡¡◊ÕÕ¬à“ߥ’„π°“√®—¥∑” √«¡∑—ß°√¡°“√-
                                                       Ë                                        È
·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ∑’ π—∫ πÿπºŸ‡â ™’¬«™“≠„π°“√¥”‡π‘πß“π§√—ßπ’‡È ªìπÕ¬à“ߥ’¬ß
                                 Ë           Ë                             È             ‘Ë



                                                              (π“¬¡—¬∏—™  “¡‡ π)
                                                         ºŸÕ”𫬰“√ ∂“∫—πª√– “∑«‘∑¬“
                                                           â

                                                      (i)
                                 ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
§≥–ºŸ®¥∑”
                                                 â—

 Ò. πæ. ¡“π               µ—ßÕ√ÿ≥»‘≈ªá
                            È                          ª√–∏“π
                                                        ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å
 Ú. π.Õ.πæ.»ÿ¿‚™§         ®‘µ√«“≥‘™                    √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
 Û. ».πæ.π‘æπ∏å           æ«ß«√‘π∑√å                   √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬
 Ù. ».æ≠.¥‘…¬“            √—µπ“°√                       ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬
 ı. æ≈.√.µ.πæ. ‘π∏ÿ™¬
                    å—    µ—π ∂‘µ¬å √.π.                ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬
 ˆ. æ≈.µ.æ≠.®‘µ∂πÕ¡        ÿ«√√≥‡µ¡’¬å                  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉∑¬
 ˜. πæ.°ƒ…≥æ—π∏å          ∫ÿ≥¬–√—µ‡«™                  §≥–·æ∑¬»“ µ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬
 ¯. º».πæ.√ÿß»—°¥‘Ï
             à            »‘«“πÿ«≤πå  —                §≥–·æ∑¬»“ µ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬
 ˘. æ.Õ.πæ. “¡“√∂         π‘∏ππ∑πå
                                ‘ —                    «‘∑¬“≈—¬·æ∑¬»“ µ√åæ√–¡ß°ÿƇ°≈â“
Ò. πæ.π—π∑»—°¥‘Ï         ∑‘»“«‘¿“µ                    §≥–·æ∑¬»“ µ√å»√√“™æ¬“∫“≈
                                                                         ‘‘
ÒÒ. ».πæ.π§√™—¬           ‡º◊Õπª∞¡
                              Ë                        §≥–·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬ ß¢≈“π§√‘π∑√å
ÒÚ. æ.Õ.πæ. ‘√√ÿ®πå        °ÿ≈≥–¡√√§“                  ‚√ßæ¬“∫“≈æ√–¡ß°ÿƇ°≈â“ °√¡·æ∑¬å∑À“√∫°
ÒÛ. π.∑.πæ.¬Õ¥√—°         ª√–‡ √‘∞                     ‚√ßæ¬“∫“≈¿Ÿ¡æ≈Õ¥ÿ≈¬‡¥™ °√¡·æ∑¬å∑À“√Õ“°“»
                                                                     ‘
ÒÙ. πæ.∏’√»—°¥‘Ï          æ◊πß“¡
                            È                          ‚√ßæ¬“∫“≈æ≠“‰∑ Ò
Òı. πæ. ¡‡°’¬√µ‘          ‚æ∏‘ µ¬å  —                   ”π—°æ—≤π“«‘™“°“√·æ∑¬å °√¡°“√·æ∑¬å
Òˆ. πæ.æ‘™µ‘              Õπÿ«≤π“«‘π
                                  ÿ ‘                   ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å
Ò˜. πæ.摇™…∞             ‡¡∏“√—°…噿   ’               ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å
Ò¯. πæ.°ÿ≈æ—≤πå           «’√ “√                        ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å
Ò˘. πæ.∏’√™—¬             º“≥‘µæß…å                     ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å
Ú. π. .Õ‘ √’             µ√’°¡≈                       ‡≈¢“πÿ°“√
                                                        ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

                                               ¢Õ¢Õ∫§ÿ≥

 Ò. ».‡°’¬√µ‘§≥ πæ.Õ√√∂ ‘∑∏‘Ï ‡«™™“™’«–
              ÿ                                        ∑’„Àâ§”·π–π”·≈–‡ªìπ∑’ª√÷°…“„π°“√®—¥∑”
                                                         Ë                  Ë
 Ú. πæ.‡ √’                   µŸ®π¥“
                                â‘                     Õ∏‘∫¥’°√¡°“√·æ∑¬å

§≥–∫√√≥“∏‘°“√ :          ».πæ.π‘æπ∏å æ«ß«√‘π∑√å
                         πæ. ¡“π µ—ßÕ√ÿ≥»‘≈ªá
                                     È
                                                   (ii)
                               ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
§≥–∑”ß“π‚§√ß°“√®—¥∑”·π«∑“߇«™ªØ‘∫µ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
                                        — ‘
                    ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å

 Ò. πæ.ª√– “∑          ‚Àµ√¿«“ππ∑å                                ∑’ª√÷°…“  Ë
 Ú πæ.¡—¬∏—™            “¡‡ π                                     ∑’ª√÷°…“Ë
 Û. πæ.æ‘™µ‘           Õπÿ«≤π“«‘πÿ ‘                              ∑’ª√÷°…“
                                                                        Ë
 Ù. πæ. ÿ™“µ‘          À“≠‰™¬æ‘∫≈¬å°≈    Ÿ ÿ                      ∑’ª√÷°…“
                                                                      Ë
 ı. æ≈.µ.πæ. ‘π∏ÿ™¬
                  å—   µ—π ∂‘µ¬å                                  ∑’ª√÷°…“
                                                                    Ë
 ˆ. πæ. ¡“π            µ—ßÕ√ÿ≥»‘≈ªá
                         È                                        ª√–∏“π
 ˜. πæ.Õπÿ»°¥‘Ï
             —         ‡≈’¬ßÕÿ¥¡                                  √Õߪ√–∏“π
 ¯. π.Õ.πæ.»ÿ¿‚™§      ®‘µ√«“≥‘™                                  §≥–∑”ß“π
 ˘. ».πæ.π‘æπ∏å        æ«ß«√‘π∑√å                                 §≥–∑”ß“π
Ò. ».æ≠.¥‘…¬“         √—µπ“°√                                    §≥–∑”ß“π
ÒÒ. æ≈.µ.æ≠.®‘µ∂πÕ¡     ÿ«√√≥‡µ¡’¬å                               §≥–∑”ß“π
ÒÚ. πæ.‰™¬«‘∑¬å        ∏π‰æ»“≈                                    §≥–∑”ß“π
ÒÛ. º.».πæ. ÿ√™—¬      ‡§“√æ∏√√¡                                  §≥–∑”ß“π
ÒÙ. √.».πæ.ª√–‡ √‘∞    »—≈¬å««√√∏πå‘                              §≥–∑”ß“π
Òı. πæ.π—π∑»—°¥‘Ï      ∑‘»“«‘¿“µ                                  §≥–∑”ß“π
Òˆ. ».πæ.π§√™—¬        ‡º◊Õπª∞¡
                             Ë                                    §≥–∑”ß“π
Ò˜. æ.Õ.πæ. ‘√√ÿ®πå     °ÿ≈≥–¡√√§“                                §≥–∑”ß“π
Ò¯. π.∑.πæ.¬Õ¥√—°      ª√–‡ √‘∞                                   §≥–∑”ß“π
Ò˘. πæ.∏’√»—°¥‘Ï       æ◊πß“¡
                           È                                      §≥–∑”ß“π
Ú. πæ. ¡‡°’¬√µ‘       ‚æ∏‘ µ¬å      —                            §≥–∑”ß“π
ÚÒ. πæ.摇™…∞          ‡¡∏“√—°…噿     ’                          §≥–∑”ß“π
ÚÚ.πæ. «‘ß             ªíπ®—¬ ’Àå                                 §≥–∑”ß“π
ÚÛ.πæ.∏’√™—¬           º“≥‘µæß»å                                  §≥–∑”ß“π
ÚÙ.πæ.°ÿ≈æ—≤πå         «’√ “√                                     ‡≈¢“πÿ°“√
Úı.πæ.ª√–‡ √‘∞         ‡Õ’¬¡ª√’™“°ÿ≈
                               Ë                                  ºŸ™«¬‡≈¢“πÿ°“√ 1
                                                                    âà
Úˆ. π. .Õ‘ √’          µ√’°¡≈                                     ºŸ™«¬‡≈¢“πÿ°“√ 2
                                                                    âà


                                           (iii)
                       ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
§”π”

                ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°‡ªìπ‚√§∑’Ëæ∫∫àÕ¬‚√§Àπ÷ËߢÕß√–∫∫ª√– “∑ ·≈–‡ªì𠓇Àµÿ
°“√µ“¬∑’ ”§—≠„πÕ—π¥—∫µâπ Ê ¢Õߪ√–‡∑»‰∑¬ ´÷ßæ∫‰¥â∫Õ¬°«à“ª√–‡∑»∑“ßµ–«—πµ°  ¡“§¡ª√– “∑-
              Ë                                 Ë         à
»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬√à«¡°—∫ ∂“∫—πª√– “∑«‘∑¬“‰¥â∑”°“√ ”√«®§«“¡§‘¥‡ÀÁπ¢Õß·æ∑¬å
∑—Ë«ª√–‡∑»‡°’ˬ«°—∫°“√√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß æ∫«à“°“√√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß„πª√–‡∑»‰∑¬
¬— ß ‡ªì π ªí ≠ À“„À≠à ∑’Ë ¡’ § «“¡À≈“°À≈“¬„π‡«™ªØ‘ ∫— µ‘   „π∞“π–∑’Ë ‡ ªì π  ∂“∫— π ‡©æ“–∑“ߢÕß
‚√§√–∫∫ª√– “∑‰¥âµ√–Àπ—°∂÷ߪí≠À“π’È ®÷߉¥â√–¥¡§≥–·æ∑¬åº‡Ÿâ ™’¬«™“≠®“°√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å
                                                                 Ë
·Ààߪ√–‡∑»‰∑¬ √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬  ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬  ¡“§¡
ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉∑¬  ”π—°æ—≤π“«‘™“°“√·æ∑¬å
°√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ·≈–§≥–·æ∑¬»“ µ√å¢Õß¡À“«‘∑¬“≈—¬µà“ß Ê ∑—«ª√–‡∑» ‡æ◊Õ      Ë        Ë
®—¥∑”·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬„Àâ¡’ª√– ‘∑∏‘¿“æ
‡À¡“– ¡°—∫·µà≈–æ◊π∑’Ë ∑”„Àâª√–™“™π¡’À≈—°ª√–°—π„π°“√√—∫∫√‘°“√∑’¡§≥¿“楒¢π
                       È                                           Ë ’ÿ          ÷È




                                                         §≥–ºŸ®¥∑”
                                                              â—
                                                       ‘ßÀ“§¡ ÚıÙ˜




                                                   (iv)
                               ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
 “√∫—≠

                                                                                Àπâ“

§”π‘¬¡                                                                           (i)

§≥–ºŸ®¥∑”
     â—                                                                         (ii)

§≥–∑”ß“π                                                                        (iii)

§”π”                                                                            (iv)

∫∑π”                                                                               1

∫∑∑’Ë 1 ·π«∑“ß°“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
        (Guidelines for the Management of Hemorrhagic Stroke)                      3

∫∑∑’Ë 2 °“√∫”∫—¥√—°…“∑“ß»—≈¬°√√¡¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
        (Surgical Management of Hemorrhagic Stroke)                                9

∫∑∑’Ë 3 °“√∫”∫—¥√—°…“∑“ßÕ“¬ÿ√°√√¡¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
        (Medical Management of Hemorrhagic Stroke)                               22

‡Õ° “√Õâ“ßÕ‘ß                                                                    23

µ“√“ß                                                                            27

¿“§ºπ«°
       1.   Siriraj Stroke Score (SSS)                                           31
       2    Glasgow Coma Scale (GCS)                                             32
       3.   CT scan of Normal Brain                                              33
       4.   Diagnosis of Hydrocephalus by CT brain                               34
       5.   CT scan of Hemorrhagic Stroke                                        35



                              ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
 “√∫—≠·ºπ¿Ÿ¡‘

                                                                       Àπâ“

·ºπ¿Ÿ¡∑’Ë 1. °“√∫”∫—¥√—°…“‡∫◊Õßµâπ·≈–°“√«‘π®©—¬‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß
      ‘                      È              ‘                           4
             (Initial Management and Diagnosis of Stroke )

·ºπ¿Ÿ¡∑’Ë 2. °“√·¬°‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°µ“¡µ”·Àπàß
      ‘                                                                 6
             (Classification of Hemorrhagic Stroke by Location)

·ºπ¿Ÿ¡∑’Ë 3. °“√∫”∫—¥√—°…“ Lobar Hemorrhage
      ‘                                                                10
             (Management of Lobar Hemorrhage)

·ºπ¿Ÿ¡∑’Ë 4. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß Basal Ganglia
      ‘                                                                12
             (Management of Basal Ganglia Hemorrhage)

·ºπ¿Ÿ¡∑’Ë 5. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß Thalamus
      ‘                                                                14
             (Management of Thalamic Hemorrhage)

·ºπ¿Ÿ¡∑’Ë 6. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß ¡ÕßπâÕ¬
      ‘                                                                16
             (Management of Cerebellar Hemorrhage)

·ºπ¿Ÿ¡∑’Ë 7. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß Pons
      ‘                                                                18
             (Management of Pontine Hemorrhage)

·ºπ¿Ÿ¡∑’Ë 8. °“√∫”∫—¥√—°…“‚√§‡≈◊Õ¥ÕÕ°„π Subarachnoid Space
      ‘                                                                20
             (Management of Subarachnoid Hemorrhage)
 “√∫—≠µ“√“ß

                                                                                Àπâ“

µ“√“ß∑’Ë 1. √–¥—∫§”·π–π”Õ‘ß§ÿ≥¿“æ¢ÕßÀ≈—°∞“π                                     27
            (Strength of Recommendation)

µ“√“ß∑’Ë 2. °“√«‘π®©—¬‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
                  ‘                                                             27
            (Diagnosis of Hemorrhagic Stroke)

µ“√“ß∑’Ë 3. °“√∫”∫—¥√—°…“∑“ßÕ“¬ÿ√°√√¡¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°                     28
            (Medical Management of Hemorrhagic Stroke)

µ“√“ß∑’Ë 4. °“√√—°…“¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿß                                 29
            (Treatment of Increased Intracranial Pressure)

µ“√“ß∑’Ë 5. ·π«∑“ß°“√ª√÷°…“ª√– “∑»—≈¬·æ∑¬å„π‡√◊Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°
                                                     Ë                          30
            (Guidelines for Neurosurgical Consultation in Hemorrhagic Stroke)

โรคหลอดเลือดสมองแตกสำหรับแำพทย์ :Front

  • 1.
    ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å (Clinical Practice Guidelines for Hemorrhagic Stroke) ‚¥¬ √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬ √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬  ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬  ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉∑¬  ”π—°æ—≤π“«‘™“°“√·æ∑¬å °√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ©∫—∫∑’Ë 1 æ.». 2547 (æ‘¡æå§√—Èß∑’Ë 1) † ISBN : 974-422-093-7
  • 2.
    ·π«∑“߇«™ªØ‘∫µπ’È ‡ªìπ‡§√◊Õß¡◊Õ à߇ √‘¡§ÿ≥¿“æ¢Õß°“√∫√‘°“√¥â“π ÿ¢¿“æ∑’‡Ë À¡“– ¡ — ‘ Ë °—∫∑√—欓°√·≈–‡ß◊Õπ‰¢ —ß§¡‰∑¬ ‚¥¬À«—ߺ≈„π°“√ √â“߇ √‘¡·≈–·°â‰¢ªí≠À“À“ ÿ¢¿“æ¢Õß Ë §π‰∑¬Õ¬à“ß¡’ª√– ‘∑∏‘¿“æ·≈–§ÿâ¡§à“ ¢âÕ·π–π”µà“ß Ê „π·π«∑“߇«™ªØ‘∫—µ‘π’ȉ¡à„™à¢âÕ§—∫ ¢Õß°“√ªØ‘∫—µ‘ ºŸâ„™â “¡“√∂ªØ‘∫—µ‘·µ°µà“߉ª®“°¢âÕ·π–π”‰¥â „π°√≥’∑’Ë ∂“π°“√≥å·µ°µà“ß ÕÕ°‰ªÀ√◊Õ¡’‡Àµÿº≈∑’ ¡§«√ ‚¥¬„™â«®“√≥≠“≥∑’‡Ë ªìπ∑’¬Õ¡√—∫„π —ß§¡ Ë ‘ Ë ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
  • 3.
    §”π‘¬¡ ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°‡ªìπ‚√§∑’Ëæ∫‰¥â∫àÕ¬ „πª√–‡∑»·∂∫‡Õ‡™’¬¡“°°«à“ª√–‡∑»∑“ßµ–«—πµ° ‚¥¬¡’Õÿ∫—µ‘°“√≥å Ÿß∂÷ß√âÕ¬≈– 25-35 ¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ´÷Ëß‚√§π’ȇªì𠓇Àµÿ°“√µ“¬·≈–§«“¡æ‘°“√ Õ—π¥—∫µâπÊ ‚¥¬‡©æ“–„πºŸâ ŸßÕ“¬ÿ ·≈–‡ªìπªí≠À“∑“ß°“√·æ∑¬å∑’Ë ”§—≠¢Õߪ√–‡∑» „πªí®®ÿ∫—πæ∫«à“¡’§«“¡ ·µ°µà“ß„π¥â“π∫ÿ§≈“°√·≈–§«“¡æ√âÕ¡¢Õ߇§√◊ËÕß¡◊Õ∑“ß°“√·æ∑¬å∑’Ë¡’À≈“¬ª√–‡¿∑·≈–¡’°“√°√–®“¬∑’ˉ¡à ‡À¡“– ¡ ®÷ß∑”„Àâ„πª√–‡∑»‰∑¬¡’‡«™ªØ‘∫—µ‘∑’ˉ¡à‡À¡◊Õπ°—π∑—Èß„π¥â“π°“√«‘π‘®©—¬·≈–√—°…“‚√§À≈Õ¥‡≈◊Õ¥  ¡Õß·µ°  ∂“∫—πª√– “∑«‘∑¬“ „π∞“𖇪ìπ ∂“∫—π«‘™“°“√‡©æ“–∑“ߥâ“π√–∫∫ª√– “∑„π√–¥—∫ Ÿß°«à“µµ‘¬¿Ÿ¡‘ ‰¥âµ√–Àπ—°∂÷ߪí≠À“¥—ß°≈à“«®÷߉¥â®¥∑”·π«∑“߇«™ªØ‘∫µ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° ”À√—∫·æ∑¬å„π√–¥—∫ª√–‡∑» — —‘ ‚¥¬√à«¡°—∫ºŸâ∑√ß§ÿ≥«ÿ≤‘·≈–ºŸâ‡™’ˬ«™“≠¥â“π‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°∑—Ë«ª√–‡∑» ‡æ◊ËÕÀ«—ß„À⇰‘¥ª√–‚¬™πå·°à ·æ∑¬åÕ¬à“ß·∑â®√‘ß„π°“√∑’Ë®–π”§«“¡√Ÿâ∑’ˉ¥â√—∫‰ªªØ‘∫—µ‘‰¥â∂Ÿ°µâÕß·≈–‡ªìπ¡“µ√∞“π‡¥’¬«°—π∑—Ë«ª√–‡∑» ‚¥¬¡’ °“√¥”‡π‘πß“π¥—ßπ’È 1. «—π∑’Ë 16 °ÿ¡¿“æ—π∏å 2547 › 20 ‡¡…“¬π 2547 ª√–™ÿ¡§≥–∑”ß“πºŸ∑√ß§ÿ≥«ÿ≤·≈–ºŸ‡â ™’¬«™“≠ √«¡ 6 §√—ß â ‘ Ë È 2. «—π∑’Ë 29 ‡¡…“¬π 2547 ®—¥ àß·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° (©∫—∫√à“ß) æ√âÕ¡·∫∫ ª√–‡¡‘π„Àâ·æ∑¬å∑—Ë«ª√–‡∑»‚¥¬ºà“π∑“ß§≥–·æ∑¬»“ µ√å¢Õß¡À“«‘∑¬“≈—¬µà“ß Ê ‚√ßæ¬“∫“≈»Ÿπ¬å ‚√ßæ¬“∫“≈®—ßÀ«—¥ ·≈–  ”π—°ß“π “∏“√≥ ÿ¢®—ßÀ«—¥ 3. «—π∑’Ë 9 › 10  ‘ßÀ“§¡ 2547 ‡™‘≠·æ∑¬å®“°∑—«ª√–‡∑»‡¢â“√à«¡ª√–™ÿ¡/ —¡¡π“ ª√—∫ª√ÿß·π«∑“ßœ (©∫—∫√à“ß) Ë 4. «—π∑’Ë 24  ‘ßÀ“§¡ 2547 ª√–™ÿ¡§≥–∑”ß“πºŸ∑√ß§ÿ≥«ÿ≤·≈–ºŸ‡â ™’¬«™“≠‡æ◊Õæ‘®“√≥“ª√—∫ª√ÿß·π«∑“ß â ‘ Ë Ë ‡«™ªØ‘∫µ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„Àâ¡§«“¡ ¡∫Ÿ√≥å ‡æ◊Õ®—¥æ‘¡æå§√—ß∑’Ë 1 ·≈–‡º¬·æ√àµÕ‰ª —‘ ’ Ë È à Õ¬à“߉√°Áµ“¡ ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°©∫—∫π’È ‡ªìπ§”·π–π”„π ‘Ëß∑’˧«√·°à °“√ªØ‘∫µ‡‘ ∑à“π—π ∑—ßπ’„π°“√ªØ‘∫µ®√‘ߢ÷π°—∫¥ÿ≈¬æ‘π®¢Õß·æ∑¬åº¥·≈ºŸª«¬¢≥–π—π‡ªìπ ”§—≠ — È È È —‘ È ‘ Ÿâ Ÿ â É È „π∑⓬∑’Ë ÿ¥π’È ∂“∫—πª√– “∑«‘∑¬“À«—߇ªìπÕ¬à“߬‘Ëß«à“ ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° ©∫—∫π’®°‡°‘¥ª√–‚¬™πå ”À√—∫·æ∑¬å∑®–𔉪ª√–¬ÿ°µå„™âÕ¬à“ß°«â“ߢ«“ß ‡æ◊Õ„Àâª√–™“™π™“«‰∑¬¡’§≥¿“æ È— ’Ë Ë ÿ ™’«µ∑’¥’ ·≈–„§√à¢Õ¢Õ∫§ÿ≥ √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬ √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬ ‘ Ë  ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬  ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥  ¡Õ߉∑¬ §≥–·æ∑¬»“ µ√宓°¡À“«‘∑¬“≈—¬µà“ß Ê ∑’‰¥â„Àâ§«“¡√à«¡¡◊ÕÕ¬à“ߥ’„π°“√®—¥∑” √«¡∑—ß°√¡°“√- Ë È ·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ∑’ π—∫ πÿπºŸ‡â ™’¬«™“≠„π°“√¥”‡π‘πß“π§√—ßπ’‡È ªìπÕ¬à“ߥ’¬ß Ë Ë È ‘Ë (π“¬¡—¬∏—™  “¡‡ π) ºŸÕ”𫬰“√ ∂“∫—πª√– “∑«‘∑¬“ â (i) ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
  • 4.
    §≥–ºŸ®¥∑” â— Ò. πæ. ¡“π µ—ßÕ√ÿ≥»‘≈ªá È ª√–∏“π  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å Ú. π.Õ.πæ.»ÿ¿‚™§ ®‘µ√«“≥‘™ √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬ Û. ».πæ.π‘æπ∏å æ«ß«√‘π∑√å √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬ Ù. ».æ≠.¥‘…¬“ √—µπ“°√  ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬ ı. æ≈.√.µ.πæ. ‘π∏ÿ™¬ å— µ—π ∂‘µ¬å √.π.  ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬ ˆ. æ≈.µ.æ≠.®‘µ∂πÕ¡  ÿ«√√≥‡µ¡’¬å  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉∑¬ ˜. πæ.°ƒ…≥æ—π∏å ∫ÿ≥¬–√—µ‡«™ §≥–·æ∑¬»“ µ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ¯. º».πæ.√ÿß»—°¥‘Ï à »‘«“πÿ«≤πå — §≥–·æ∑¬»“ µ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ˘. æ.Õ.πæ. “¡“√∂ π‘∏ππ∑πå ‘ — «‘∑¬“≈—¬·æ∑¬»“ µ√åæ√–¡ß°ÿƇ°≈â“ Ò. πæ.π—π∑»—°¥‘Ï ∑‘»“«‘¿“µ §≥–·æ∑¬»“ µ√å»√√“™æ¬“∫“≈ ‘‘ ÒÒ. ».πæ.π§√™—¬ ‡º◊Õπª∞¡ Ë §≥–·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬ ß¢≈“π§√‘π∑√å ÒÚ. æ.Õ.πæ. ‘√√ÿ®πå  °ÿ≈≥–¡√√§“ ‚√ßæ¬“∫“≈æ√–¡ß°ÿƇ°≈â“ °√¡·æ∑¬å∑À“√∫° ÒÛ. π.∑.πæ.¬Õ¥√—° ª√–‡ √‘∞ ‚√ßæ¬“∫“≈¿Ÿ¡æ≈Õ¥ÿ≈¬‡¥™ °√¡·æ∑¬å∑À“√Õ“°“» ‘ ÒÙ. πæ.∏’√»—°¥‘Ï æ◊πß“¡ È ‚√ßæ¬“∫“≈æ≠“‰∑ Ò Òı. πæ. ¡‡°’¬√µ‘ ‚æ∏‘ µ¬å —  ”π—°æ—≤π“«‘™“°“√·æ∑¬å °√¡°“√·æ∑¬å Òˆ. πæ.æ‘™µ‘ Õπÿ«≤π“«‘π ÿ ‘  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å Ò˜. πæ.摇™…∞ ‡¡∏“√—°…噿 ’  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å Ò¯. πæ.°ÿ≈æ—≤πå «’√ “√  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å Ò˘. πæ.∏’√™—¬ º“≥‘µæß…å  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å Ú. π. .Õ‘ √’ µ√’°¡≈ ‡≈¢“πÿ°“√  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å ¢Õ¢Õ∫§ÿ≥ Ò. ».‡°’¬√µ‘§≥ πæ.Õ√√∂ ‘∑∏‘Ï ‡«™™“™’«– ÿ ∑’„Àâ§”·π–π”·≈–‡ªìπ∑’ª√÷°…“„π°“√®—¥∑” Ë Ë Ú. πæ.‡ √’ µŸ®π¥“ â‘ Õ∏‘∫¥’°√¡°“√·æ∑¬å §≥–∫√√≥“∏‘°“√ : ».πæ.π‘æπ∏å æ«ß«√‘π∑√å πæ. ¡“π µ—ßÕ√ÿ≥»‘≈ªá È (ii) ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
  • 5.
    §≥–∑”ß“π‚§√ß°“√®—¥∑”·π«∑“߇«™ªØ‘∫µ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° — ‘  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å Ò. πæ.ª√– “∑ ‚Àµ√¿«“ππ∑å ∑’ª√÷°…“ Ë Ú πæ.¡—¬∏—™  “¡‡ π ∑’ª√÷°…“Ë Û. πæ.æ‘™µ‘ Õπÿ«≤π“«‘πÿ ‘ ∑’ª√÷°…“ Ë Ù. πæ. ÿ™“µ‘ À“≠‰™¬æ‘∫≈¬å°≈ Ÿ ÿ ∑’ª√÷°…“ Ë ı. æ≈.µ.πæ. ‘π∏ÿ™¬ å— µ—π ∂‘µ¬å ∑’ª√÷°…“ Ë ˆ. πæ. ¡“π µ—ßÕ√ÿ≥»‘≈ªá È ª√–∏“π ˜. πæ.Õπÿ»°¥‘Ï — ‡≈’¬ßÕÿ¥¡ √Õߪ√–∏“π ¯. π.Õ.πæ.»ÿ¿‚™§ ®‘µ√«“≥‘™ §≥–∑”ß“π ˘. ».πæ.π‘æπ∏å æ«ß«√‘π∑√å §≥–∑”ß“π Ò. ».æ≠.¥‘…¬“ √—µπ“°√ §≥–∑”ß“π ÒÒ. æ≈.µ.æ≠.®‘µ∂πÕ¡  ÿ«√√≥‡µ¡’¬å §≥–∑”ß“π ÒÚ. πæ.‰™¬«‘∑¬å ∏π‰æ»“≈ §≥–∑”ß“π ÒÛ. º.».πæ. ÿ√™—¬ ‡§“√æ∏√√¡ §≥–∑”ß“π ÒÙ. √.».πæ.ª√–‡ √‘∞ »—≈¬å««√√∏πå‘ §≥–∑”ß“π Òı. πæ.π—π∑»—°¥‘Ï ∑‘»“«‘¿“µ §≥–∑”ß“π Òˆ. ».πæ.π§√™—¬ ‡º◊Õπª∞¡ Ë §≥–∑”ß“π Ò˜. æ.Õ.πæ. ‘√√ÿ®πå  °ÿ≈≥–¡√√§“ §≥–∑”ß“π Ò¯. π.∑.πæ.¬Õ¥√—° ª√–‡ √‘∞ §≥–∑”ß“π Ò˘. πæ.∏’√»—°¥‘Ï æ◊πß“¡ È §≥–∑”ß“π Ú. πæ. ¡‡°’¬√µ‘ ‚æ∏‘ µ¬å — §≥–∑”ß“π ÚÒ. πæ.摇™…∞ ‡¡∏“√—°…噿 ’ §≥–∑”ß“π ÚÚ.πæ. «‘ß ªíπ®—¬ ’Àå §≥–∑”ß“π ÚÛ.πæ.∏’√™—¬ º“≥‘µæß»å §≥–∑”ß“π ÚÙ.πæ.°ÿ≈æ—≤πå «’√ “√ ‡≈¢“πÿ°“√ Úı.πæ.ª√–‡ √‘∞ ‡Õ’¬¡ª√’™“°ÿ≈ Ë ºŸ™«¬‡≈¢“πÿ°“√ 1 âà Úˆ. π. .Õ‘ √’ µ√’°¡≈ ºŸ™«¬‡≈¢“πÿ°“√ 2 âà (iii) ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
  • 6.
    §”π” ‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°‡ªìπ‚√§∑’Ëæ∫∫àÕ¬‚√§Àπ÷ËߢÕß√–∫∫ª√– “∑ ·≈–‡ªì𠓇Àµÿ °“√µ“¬∑’ ”§—≠„πÕ—π¥—∫µâπ Ê ¢Õߪ√–‡∑»‰∑¬ ´÷ßæ∫‰¥â∫Õ¬°«à“ª√–‡∑»∑“ßµ–«—πµ°  ¡“§¡ª√– “∑- Ë Ë à »—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬√à«¡°—∫ ∂“∫—πª√– “∑«‘∑¬“‰¥â∑”°“√ ”√«®§«“¡§‘¥‡ÀÁπ¢Õß·æ∑¬å ∑—Ë«ª√–‡∑»‡°’ˬ«°—∫°“√√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß æ∫«à“°“√√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß„πª√–‡∑»‰∑¬ ¬— ß ‡ªì π ªí ≠ À“„À≠à ∑’Ë ¡’ § «“¡À≈“°À≈“¬„π‡«™ªØ‘ ∫— µ‘ „π∞“π–∑’Ë ‡ ªì π  ∂“∫— π ‡©æ“–∑“ߢÕß ‚√§√–∫∫ª√– “∑‰¥âµ√–Àπ—°∂÷ߪí≠À“π’È ®÷߉¥â√–¥¡§≥–·æ∑¬åº‡Ÿâ ™’¬«™“≠®“°√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å Ë ·Ààߪ√–‡∑»‰∑¬ √“™«‘∑¬“≈—¬Õ“¬ÿ√·æ∑¬å·Ààߪ√–‡∑»‰∑¬  ¡“§¡ª√– “∑«‘∑¬“·Ààߪ√–‡∑»‰∑¬  ¡“§¡ ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬  ¡“§¡‚√§À≈Õ¥‡≈◊Õ¥ ¡Õ߉∑¬  ”π—°æ—≤π“«‘™“°“√·æ∑¬å °√¡°“√·æ∑¬å °√–∑√«ß “∏“√≥ ÿ¢ ·≈–§≥–·æ∑¬»“ µ√å¢Õß¡À“«‘∑¬“≈—¬µà“ß Ê ∑—«ª√–‡∑» ‡æ◊Õ Ë Ë ®—¥∑”·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫°“√¥Ÿ·≈√—°…“ºŸâªÉ«¬„Àâ¡’ª√– ‘∑∏‘¿“æ ‡À¡“– ¡°—∫·µà≈–æ◊π∑’Ë ∑”„Àâª√–™“™π¡’À≈—°ª√–°—π„π°“√√—∫∫√‘°“√∑’¡§≥¿“楒¢π È Ë ’ÿ ÷È §≥–ºŸ®¥∑” â—  ‘ßÀ“§¡ ÚıÙ˜ (iv) ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
  • 7.
     “√∫—≠ Àπâ“ §”π‘¬¡ (i) §≥–ºŸ®¥∑” â— (ii) §≥–∑”ß“π (iii) §”π” (iv) ∫∑π” 1 ∫∑∑’Ë 1 ·π«∑“ß°“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° (Guidelines for the Management of Hemorrhagic Stroke) 3 ∫∑∑’Ë 2 °“√∫”∫—¥√—°…“∑“ß»—≈¬°√√¡¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° (Surgical Management of Hemorrhagic Stroke) 9 ∫∑∑’Ë 3 °“√∫”∫—¥√—°…“∑“ßÕ“¬ÿ√°√√¡¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° (Medical Management of Hemorrhagic Stroke) 22 ‡Õ° “√Õâ“ßÕ‘ß 23 µ“√“ß 27 ¿“§ºπ«° 1. Siriraj Stroke Score (SSS) 31 2 Glasgow Coma Scale (GCS) 32 3. CT scan of Normal Brain 33 4. Diagnosis of Hydrocephalus by CT brain 34 5. CT scan of Hemorrhagic Stroke 35 ·π«∑“߇«™ªØ‘∫—µ‘‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°  ”À√—∫·æ∑¬å
  • 8.
     “√∫—≠·ºπ¿Ÿ¡‘ Àπâ“ ·ºπ¿Ÿ¡∑’Ë 1. °“√∫”∫—¥√—°…“‡∫◊Õßµâπ·≈–°“√«‘π®©—¬‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß ‘ È ‘ 4 (Initial Management and Diagnosis of Stroke ) ·ºπ¿Ÿ¡∑’Ë 2. °“√·¬°‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°µ“¡µ”·Àπàß ‘ 6 (Classification of Hemorrhagic Stroke by Location) ·ºπ¿Ÿ¡∑’Ë 3. °“√∫”∫—¥√—°…“ Lobar Hemorrhage ‘ 10 (Management of Lobar Hemorrhage) ·ºπ¿Ÿ¡∑’Ë 4. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß Basal Ganglia ‘ 12 (Management of Basal Ganglia Hemorrhage) ·ºπ¿Ÿ¡∑’Ë 5. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß Thalamus ‘ 14 (Management of Thalamic Hemorrhage) ·ºπ¿Ÿ¡∑’Ë 6. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß ¡ÕßπâÕ¬ ‘ 16 (Management of Cerebellar Hemorrhage) ·ºπ¿Ÿ¡∑’Ë 7. °“√∫”∫—¥√—°…“‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ°„πµ”·Àπàß Pons ‘ 18 (Management of Pontine Hemorrhage) ·ºπ¿Ÿ¡∑’Ë 8. °“√∫”∫—¥√—°…“‚√§‡≈◊Õ¥ÕÕ°„π Subarachnoid Space ‘ 20 (Management of Subarachnoid Hemorrhage)
  • 9.
     “√∫—≠µ“√“ß Àπâ“ µ“√“ß∑’Ë 1. √–¥—∫§”·π–π”Õ‘ß§ÿ≥¿“æ¢ÕßÀ≈—°∞“π 27 (Strength of Recommendation) µ“√“ß∑’Ë 2. °“√«‘π®©—¬‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° ‘ 27 (Diagnosis of Hemorrhagic Stroke) µ“√“ß∑’Ë 3. °“√∫”∫—¥√—°…“∑“ßÕ“¬ÿ√°√√¡¢Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° 28 (Medical Management of Hemorrhagic Stroke) µ“√“ß∑’Ë 4. °“√√—°…“¿“«–§«“¡¥—π„π°–‚À≈°»’√…– Ÿß 29 (Treatment of Increased Intracranial Pressure) µ“√“ß∑’Ë 5. ·π«∑“ß°“√ª√÷°…“ª√– “∑»—≈¬·æ∑¬å„π‡√◊Õß‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·µ° Ë 30 (Guidelines for Neurosurgical Consultation in Hemorrhagic Stroke)