บทที่ 7 - TMCHNtmchnetwork.com/sites/default/files/3. Successfully tocolytic therapy for...

บทท 7 ผลสำเรจของการยบยงการคลอด กอนกำหนดของโรงพยาบาลจฬาลงกรณ สภากาชาดไทย

√Õß»“ µ√“®“√¬å π“¬·æ∑¬å«√æß»å ¿Ÿàæß»å

¿“§«‘™“ Ÿµ‘»“ µ√å-π√’‡«™«‘∑¬“ §≥–·æ∑¬»“ µ√å ®ÿÃ“≈ß°√≥å¡À“«‘∑¬“≈—¬

216

∫∑∑’Ë 7 º≈ ”‡√Á®¢Õß°“√¬—∫¬—Èß°“√§≈Õ¥°àÕπ°”Àπ¥¢Õß‚√ßæ¬“∫“≈®ÿÃ“≈ß°√≥å ¿“°“™“¥‰∑¬

ผลสำเรจของการยบยงการคลอดกอนกำหนด ของโรงพยาบาลจฬาลงกรณ สภากาชาดไทย

√Õß»“ µ√“®“√¬å π“¬·æ∑¬å«√æß»å ¿Ÿàæß»å

¿“§«‘™“ Ÿµ‘»“ µ√å-π√’‡«™«‘∑¬“ §≥–·æ∑¬»“ µ√å ®ÿÃ“≈ß°√≥å¡À“«‘∑¬“≈—¬

บทนำ

°“√‡®Á∫§√√¿å·≈–°“√§≈Õ¥°àÕπ°”Àπ¥‡ªìπªí≠À“Àπ÷Ëß∑’Ë ”§—≠∑“ß Ÿµ‘»“ µ√å ´÷Ëß°àÕ„Àâ‡°‘¥¿“«–∑ÿææ≈¿“æ

·≈–°“√‡ ’¬™’«‘µ¢Õß∑“√° √âÕ¬≈– 75

¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ §◊Õ ¿“«–∑’Ë¡’°“√‡®Á∫§√√¿å µ—Èß·µàÕ“¬ÿ§√√¿å 28 —ª¥“Àå („πª√–‡∑»∑’Ë

æ—≤π“„™âµ—Èß·µàÕ“¬ÿ§√√¿å 20 —ª¥“Àå) ·≈–°àÕπÕ“¬ÿ§√√¿å 37 —ª¥“Àå1,2

¿“«–§≈Õ¥°àÕπ°”Àπ¥ §◊Õ °“√§≈Õ¥∑’Ë¡’Õ“¬ÿ§√√¿åµ—Èß·µà 28 —ª¥“Àå ·≈–‡°‘¥°àÕπÕ“¬ÿ§√√¿å 37 —ª¥“Àå

∑“√°πÈ”Àπ—°·√°‡°‘¥πâÕ¬°«à“ 2,500 °√—¡ ‡√’¬°«à“ ∑“√°πÈ”Àπ—°πâÕ¬2

อบตการณ

¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ æ∫‰¥â√âÕ¬≈– 7-12 ¢Õß°“√µ—Èß§√√¿å3,4 ´÷Ëß·µ°µà“ß°—π‰ª„πª√–™“°√

·µà≈–°≈ÿà¡ Õÿ∫—µ‘°“√≥å„π‚√ßæ¬“∫“≈®ÿÃ“≈ß°√≥å æ∫√âÕ¬≈– 9-10 ¢Õß°“√§≈Õ¥5

สาเหตของภาวะเจบครรภคลอดกอนกำหนด

“‡Àµÿ∑’Ë·∑â®√‘ß¬—ß‰¡à∑√“∫·πà™—¥ ·µàæ∫«à“‡°‘¥®“°À≈“¬Ê “‡Àµÿ (multifactorial)6 ªí®®—¬‡ ’Ë¬ß∑’Ë‡°’Ë¬«¢âÕß

°—∫¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥· ¥ß„πµ“√“ß∑’Ë 17-10

“‡Àµÿ¢Õß°“√§≈Õ¥°àÕπ°”Àπ¥ “¡“√∂·∫àßÕÕ°‰¥â‡ªìπ 3 °≈ÿà¡„À≠àÊ2-11 ¥—ßπ’È

1. Indicated preterm deliveries (¿“«–∑’Ë®”‡ªìπµâÕß§≈Õ¥°àÕπ°”Àπ¥) æ∫√âÕ¬≈– 20-30 ¢Õß°“√§≈Õ¥

°àÕπ°”Àπ¥ ‡ªìπº≈®“°‚√§·∑√°´âÕπ∑“ßÕ“¬ÿ√°√√¡ »—≈¬°√√¡ À√◊Õ Ÿµ‘°√√¡ ∑’Ë‡ªìπÕ—πµ√“¬µàÕ¡“√¥“À√◊Õ∑“√°

„π§√√¿å ∑”„ÀâµâÕß ‘Èπ ÿ¥°“√µ—Èß§√√¿å°àÕπ§√∫°”Àπ¥ ‡æ◊ËÕªÑÕß°—π¿“«–·∑√°´âÕπµàÕ¡“√¥“·≈–∑“√° ‰¥â·°à ¿“«–

§√√¿å‡ªìπæ‘…√–¬–™—°™π‘¥√ÿπ·√ß §«“¡¥—π‚≈À‘µ Ÿß‡√◊ÈÕ√—ß ‡∫“À«“π ¿“«–√°‡°“–µË” ¿“«–√°≈Õ°µ—«°àÕπ°”Àπ¥

·≈–¿“«–∑“√°‚µ™â“„π§√√¿å

2. ¿“«–∂ÿßπÈ”§√Ë”·µ°°àÕπ°“√‡®Á∫§√√¿å§≈Õ¥∑’Ë°“√µ—Èß§√√¿å¬—ß‰¡à§√∫°”Àπ¥12

3. ¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥

217

°“√ √â“ß§«“¡‡¢â¡·¢Áß¢Õß‡§√◊Õ¢à“¬ ÿ¢¿“æ¡“√¥“·≈–∑“√°‡æ◊ËÕ°“√¥Ÿ·≈¿“«–§≈Õ¥°àÕπ°”Àπ¥

¿“«–„π¢âÕ 2 ·≈– 3 æ∫√âÕ¬≈– 70-80 ¢Õß°“√§≈Õ¥°àÕπ°”Àπ¥ ∑—Èß Õß¿“«–¡’§«“¡‡°’Ë¬«¢âÕß°—π

‰¡à “¡“√∂·¬°ÕÕ°®“°°—π‰¥â‡¥Á¥¢“¥

µ“√“ß∑’Ë 1 ªí®®—¬‡ ’Ë¬ß¢Õß°“√‡°‘¥¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥7-10

Previous preterm delivery Low socioeconomic status Maternal race (black > non-black) Low body mass index Maternal age < 18 years or > 40 years Preterm PROM Multiple gestation Maternal history of one or more spontaneous second-trimester abortions Maternal complications (medical or obstetric) - Maternal behaviors - Smoking - Illicit drug use (ie, amphetamine) - Alcohol use - Anemia - Lack or inadequate prenatal care Uterine causes - Myoma uteri (particularly submucosa or subplacenta) - Uterine septum - Bicornuate uterus - Cervical incompetence - Exposure to diethylstilbestrol (DES) Infectious causes - Chorioamnionitis - Bacterial vaginosis - Asymptomatic bacteriuria - Acute pyelonephritis - Cervical/vaginal colonization Fetal causes - Intrauterine fetal death - Fetal growth restriction - Congenital anomalies Abnormal placentation

Presence of a retained intrauterine device

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การวนจฉย

°“√«‘π‘®©—¬¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ ¢÷Èπ°—∫°“√µ√«®æ∫°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° ·≈–°“√

‡ª≈’Ë¬π·ª≈ß¢Õßª“°¡¥≈Ÿ° ‚¥¬¡’°“√À¥√—¥µ—«Õ¬à“ßπâÕ¬ 4 §√—Èß„π 20 π“∑’ À√◊Õ 6 §√—Èß„π 60 π“∑’ ·≈–ª“°¡¥≈Ÿ°

∫“ßµ—«Õ¬à“ßπâÕ¬√âÕ¬≈– 80 ·≈–/À√◊Õª“°¡¥≈Ÿ°‡ªî¥¡“°°«à“ 1 ‡´πµ‘‡¡µ√2 °“√«‘π‘®©—¬‡ªìπ ‘ËßÀπ÷Ëß∑’Ë∑â“∑“¬·æ∑¬å

ºŸâ¥Ÿ·≈ ‡π◊ËÕß®“°À“°«‘π‘®©—¬«à“‡ªìπ¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥‚¥¬∑’Ë‰¡à‰¥â‡ªìπ®√‘ß ∑”„ÀâµâÕß„™â¬“¬—∫¬—Èß°“√

À¥√—¥µ—«¢Õß¡¥≈Ÿ°‚¥¬‰¡à®”‡ªìπ ´÷ËßπÕ°®“°®– Ÿ≠‡ ’¬§à“„™â®à“¬·≈â« ¬—ß∑”„Àâ‡°‘¥§«“¡‡ ’Ë¬ßµàÕ¡“√¥“·≈–∑“√°

„π§√√¿å À“°«‘π‘®©—¬‰¥â™â“®–∑”„Àâ‡°‘¥§«“¡≈â¡‡À≈«„π°“√„Àâ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°

การดแลรกษา

°“√¥Ÿ·≈√—°…“¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥π—Èπ ¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°

‡æ◊ËÕ‡≈◊ËÕπ√–¬–‡«≈“°“√§≈Õ¥ÕÕ°‰ª ·≈–„Àâ∑“√°¡’¿“«–∑’Ë‡À¡“– ¡°àÕπ°“√§≈Õ¥°àÕπ°”Àπ¥4,13,14 ¬“¬—∫¬—Èß°“√

À¥√—¥µ—«¢Õß¡¥≈Ÿ°‡ªìπ¬“∑’Ë„™â∫àÕ¬„π°“√¥Ÿ·≈√—°…“¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ ¡’¥—ßπ’È

1. ยายบยงการหดรดตวของมดลก

‡ªìπ∑’Ë √ÿª°—π·≈â««à“¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°¡’ª√– ‘∑∏‘¿“æ„π°“√¥Ÿ·≈√—°…“¿“«–‡®Á∫§√√¿å§≈Õ¥

°àÕπ°”Àπ¥‚¥¬¬◊¥√–¬–‡«≈“°“√§≈Õ¥ÕÕ°‰ª4,14 °“√‡≈◊Õ°„™â¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°°≈ÿà¡„¥π—Èπ ·æ∑¬å

ºŸâ¥Ÿ·≈§«√æ‘®“√≥“„Àâ‡À¡“– ¡°—∫ µ√’µ—Èß§√√¿å·µà≈–√“¬ ‚¥¬æ‘®“√≥“®“°¢âÕ∫àß™’È ·≈–¢âÕÀâ“¡¢Õß¬“™π‘¥µà“ßÊ

§«√¬◊¥√–¬–‡«≈“°“√§≈Õ¥ÕÕ°‰ªÕ¬à“ßπâÕ¬ 48 ™—Ë«‚¡ß ‡æ◊ËÕ„Àâ¬“§Õ√åµ‘‚§ ‡µ’¬√Õ¬¥å∑’Ë„Àâ√à«¡¥â«¬ÕÕ°ƒ∑∏‘Ï°√–µÿâπ

°“√‡®√‘≠‡µ‘∫‚µ¢ÕßªÕ¥¢Õß∑“√°„π§√√¿å15 πÕ°®“°π’È ¬—ß¡’‡«≈“æÕ∑’Ë®–π” µ√’µ—Èß§√√¿å àßµàÕ‰ª¬—ß‚√ßæ¬“∫“≈∑’Ë¡’

§«“¡ “¡“√∂¥â“π°“√¥Ÿ·≈∑“√°‡°‘¥°àÕπ°”Àπ¥

¢âÕ∫àß™’È16 ¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥

¢âÕÀâ“¡16

1. ¥â“π¡“√¥“

1.1 °“√µ‘¥‡™◊ÈÕ„π∂ÿßπÈ”§√Ë”

1.2 °“√‡ ’¬‡≈◊Õ¥Õ¬à“ß√ÿπ·√ß√–À«à“ßµ—Èß§√√¿å

1.3 §«“¡¥—π‚≈À‘µ Ÿß (pregnancy-induced hypertension)

1.4 ‚√§·∑√°´âÕπ∑“ßÕ“¬ÿ√°√√¡∑’Ë¡’¢âÕ∫àßÀâ“¡µàÕ°“√„™â¬“

1.5 ‚√§·∑√°´âÕπ∑“ßÕ“¬ÿ√°√√¡∑’Ë‰¡à§«√¥”‡π‘π°“√µ—Èß§√√¿åµàÕ‰ª

219


2. ¥â“π∑“√°

2.1 ∑“√°‡ ’¬™’«‘µ„π§√√¿å

2.2 ∑“√°æ‘°“√∑’Ë‰¡à “¡“√∂¡’™’«‘µÕ¬Ÿà‰¥â (fetal anomaly incompatible with life)

2.3 ¿“«–¢Õß∑“√°∑’Ë¡’Õ—πµ√“¬ À“°ª≈àÕ¬„Àâ°“√µ—Èß§√√¿å¥”‡π‘πµàÕ‰ª

2.4 ∑“√°∑’ËªÕ¥‡®√‘≠ ¡∫Ÿ√≥å (documented fetal maturity)

¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° “¡“√∂·∫àß‡ªìπ°≈ÿà¡ 2,4-6,15 ¥—ßπ’È

1. ¬“°≈ÿà¡ betamimetic

2. ¬“ magnesium sulfate

3. ¬“°≈ÿà¡ calcium channel blockers

4. ¬“°≈ÿà¡ prostaglandin synthetase inhibitors

5. ¬“ nitric oxide

6. ¬“ oxytocin antagonists

¬“·µà≈–™π‘¥ÕÕ°ƒ∑∏‘Ï¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°∑’Ëµ”·Àπàßµà“ß°—π ¥—ß· ¥ß„π·ºπ¿Ÿ¡‘∑’Ë 1

·ºπ¿Ÿ¡‘∑’Ë 1 µ”·Àπàß°“√ÕÕ°ƒ∑∏‘Ï¢Õß¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°17

220


ยากลม betamimetic4,5,15

°≈‰°°“√ÕÕ°ƒ∑∏‘Ï ¬“°≈ÿà¡ β2 agonists ÕÕ°ƒ∑∏‘Ï∑’Ëµ—«√—∫ (receptors) „π¡¥≈Ÿ° ‚¥¬‡æ‘Ë¡ cyclic

adenosine monophosphate „π‡´≈≈å°≈â“¡‡π◊ÈÕ ∑”„Àâ·§≈‡´’¬¡Õ‘ √–≈¥≈ß ®÷ß‰ª¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß°≈â“¡‡π◊ÈÕ

¡¥≈Ÿ° ¬“„π°≈ÿà¡π’È ‰¥â·°à ritodrine, terbutaline, albuterol, fenoterol, hexoprenaline, isoxsuprine,

metaproterenol, nylidrine, orciprenaline ·≈– salbutamol ‚¥¬∑’Ë¬“ ritodrine ‡ªìπ¬“∑’Ë FDA ¬Õ¡√—∫

¢π“¥·≈–«‘∏’°“√„™â

Ritodrine ‡√‘Ë¡„Àâ¬“À¬¥∑“ßÀ≈Õ¥‡≈◊Õ¥¥” ¢π“¥ 50-100 ‰¡‚§√°√—¡µàÕπ“∑’ ‡æ‘Ë¡‰¥â 50 ‰¡‚§√°√—¡µàÕ

π“∑’ ∑ÿ°Ê 10 π“∑’ ®π¡¥≈Ÿ°À¬ÿ¥À¥√—¥µ—«À√◊Õ¡’º≈¢â“ß‡§’¬ß ( Ÿß ÿ¥ 350 ‰¡‚§√°√—¡µàÕπ“∑’)

Terbutaline ‡√‘Ë¡„Àâ¬“À¬¥‡¢â“À≈Õ¥‡≈◊Õ¥¥” ¢π“¥ 5-10 ‰¡‚§√°√—¡µàÕπ“∑’ ( Ÿß ÿ¥ 80 ‰¡‚§√°√—¡µàÕ

π“∑’) À√◊Õ ¢π“¥ 0.25 ¡‘≈≈‘°√—¡ ©’¥‡¢â“™—Èπ„µâº‘«Àπ—ß∑ÿ° 20 π“∑’

Salbutamol ‡√‘Ë¡„Àâ¬“À¬¥∑“ßÀ≈Õ¥‡≈◊Õ¥¥” ¢π“¥ 10 ‰¡‚§√°√—¡µàÕπ“∑’ ‡æ‘Ë¡‰¥â 5 ‰¡‚§√°√—¡µàÕπ“∑’

∑ÿ°Ê 10 π“∑’ ®π°√–∑—Ëß¡¥≈Ÿ°À¬ÿ¥À¥√—¥µ—« ( Ÿß ÿ¥ 50 ‰¡‚§√°√—¡µàÕπ“∑’)

¡’°“√»÷°…“„πª√–‡∑»‰∑¬‡√◊ËÕß°“√„™â¬“ salbutamol ¢π“¥ Ÿß„π√Ÿª·∫∫°“√√—∫ª√–∑“π ¢π“¥

8 ¡‘≈≈‘°√—¡ ∑ÿ° 6 ™—Ë«‚¡ß ‡æ◊ËÕ¬—∫¬—Èß°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ æ∫«à“‰¥âº≈ 60%18 Õ“®‡ªìπ∑“ß‡≈◊Õ°Àπ÷Ëß

„π‚√ßæ¬“∫“≈∑’Ë‰¡à “¡“√∂„Àâ¬“„π√Ÿª·∫∫Õ◊Ëπ

¢âÕÀâ“¡ §«√À≈’°‡≈’Ë¬ß„πºŸâªÉ«¬∑’Ë¡’°“√‡µâπ¢ÕßÀ—«„®º‘¥ª°µ‘ ¿“«–‰∑√Õ¬¥å‡ªìπæ‘…∑’Ë¬—ß§«∫§ÿ¡‰¥â‰¡à¥’

¿“«–‡∫“À«“π∑’Ë§«∫§ÿ¡‰¥â‰¡à¥’

º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ‰¥â·°à √–∫∫À—«„®·≈–√–∫∫À“¬„® (À—«„®‡µâπ‡√Á« §«“¡¥—π‚≈À‘µµË” À—«„®‡µâπ

º‘¥ª°µ‘ °≈â“¡‡π◊ÈÕÀ—«„®¢“¥‡≈◊Õ¥ ¿“«–πÈ”§—Ëß„πªÕ¥) √–∫∫‡¡µ“∫Õ≈‘ ¡å (πÈ”µ“≈„π‡≈◊Õ¥ Ÿß ‚ª‡‡µ ‡´’¬¡„π‡≈◊Õ¥

µË”) ¡◊Õ —Ëπ „® —Ëπ µ◊Ëπ‡µâπ °√–«π°√–«“¬ §≈◊Ëπ‰ âÕ“‡®’¬π ª«¥»’√…– ‡®Á∫Àπâ“Õ° ·≈–À“¬„®‰¡à ÿ¥

º≈¢â“ß‡§’¬ßµàÕ∑“√° ‰¥â·°à À—«„®‡µâπ‡√Á« ¿“«–πÈ”µ“≈µË” ¿“«–µ—«‡À≈◊Õß ·§≈‡´’¬¡µË”

Magnesium sulfate4,5,15

°≈‰°°“√ÕÕ°ƒ∑∏‘Ï Magnesium ion ·¬àß·§≈‡´’¬¡‡¢â“ Ÿà‡´≈≈å°≈â“¡‡π◊ÈÕ¡¥≈Ÿ° ∑”„Àâ√–¥—∫·§≈‡´’¬¡Õ‘ √–

≈¥≈ß ®÷ß≈¥°“√À¥√—¥µ—«¢Õß°≈â“¡‡π◊ÈÕ¡¥≈Ÿ°

¢π“¥·≈–«‘∏’„™â „Àâ∑“ßÀ≈Õ¥‡≈◊Õ¥¥” ‡√‘Ë¡¥â«¬¢π“¥ 4-6 °√—¡ ∑“ßÀ≈Õ¥‡≈◊Õ¥¥”™â“Ê „π‡«≈“ 20 π“∑’

µ“¡¥â«¬°“√À¬¥‡¢â“À≈Õ¥‡≈◊Õ¥¥”„πÕ—µ√“ 2-4 °√—¡µàÕ™—Ë«‚¡ß °“√ª√—∫¢π“¥¢Õß¬“„Àâæ‘®“√≥“µ“¡°“√À¥√—¥µ—«

¢Õß¡¥≈Ÿ° º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ·≈–°“√∑”ß“π¢Õß‰µ

221


¢âÕÀâ“¡ ‚√§ Myasthenia gravis À√◊Õ§«“¡º‘¥ª°µ‘¢ÕßÀ—«„® (marginal cardiac compensation)

§«√√–¡—¥√–«—ß°“√„™â„πºŸâªÉ«¬‚√§‰µ

º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ‰¥â·°à √âÕπ«Ÿ∫«“∫ ´÷¡ ª«¥»’√…– °≈â“¡‡π◊ÈÕÕàÕπ·√ß ¡Õß‡ÀÁπ¿“æ´âÕπ ª“°·Àâß

§≈◊Ëπ‰ âÕ“‡®’¬π À“¬„®‰¡à ÿ¥ ·≈–¿“«–πÈ”§—Ëß„πªÕ¥ ‡æ◊ËÕ≈¥Õ“°“√¢â“ß‡§’¬ß∫“ßÕ¬à“ß §«√µ‘¥µ“¡ª√‘¡“≥ªí “«–

deep tendon reflexes ™’æ®√ Õ—µ√“À“¬„® ·≈–øíß‡ ’¬ß°“√À“¬„®√–À«à“ß∑’Ë„Àâ¬“ ·≈–®—¥‡µ√’¬¡ calcium gluconate

1 °√—¡ ‰«â·°â‰¢ À“°‡°‘¥¿“«–æ‘…®“°¬“

º≈¢â“ß‡§’¬ßµàÕ∑“√° ‰¥â·°à ´÷¡·≈–ÕàÕπ·√ß Õ“®æ∫°“√À“¬„®¢Õß∑“√°∂Ÿ°°¥ ∂â“„Àâ‡°‘π 7 «—π Õ“®æ∫

¿“«–°√–¥Ÿ°∫“ß (demineralization)

¡’°“√√«∫√«¡√“¬ß“π°“√„™â¬“ magnesium sulfate æ∫«à“ “¡“√∂¬◊¥√–¬–‡«≈“°“√§≈Õ¥À√◊ÕªÑÕß°—π

°“√§≈Õ¥°àÕπ°”Àπ¥ ·µà‡æ‘Ë¡Õ—µ√“°“√‡ ’¬™’«‘µ¢Õß∑“√°19 ¥—ßπ—Èπ ®÷ß§«√√–¡—¥√–«—ß„π°“√π”¡“„™â

ยากลม calcium channel blockers4,5,15

°≈‰°°“√ÕÕ°ƒ∑∏‘Ï ¬—∫¬—Èß·§≈‡´’¬¡‡¢â“ Ÿà‡´≈≈å°≈â“¡‡π◊ÈÕ¡¥≈Ÿ° ∑”„Àâ√–¥—∫·§≈‡´’¬¡„π‡´≈≈å≈¥≈ß

®÷ß∑”„Àâ°“√À¥√—¥µ—«¢Õß°≈â“¡‡π◊ÈÕ¡¥≈Ÿ°≈¥≈ß

¢π“¥·≈–«‘∏’„™â °“√„Àâ¬“‡√‘Ë¡·√°¡’À≈“¬«‘∏’ ¥—ßπ’È

1. Nifedipine 10 ¡‘≈≈‘°√—¡ „µâ≈‘Èπ ∑ÿ° 20 π“∑’ ‡ªìπ®”π«π 3 §√—Èß

2. Nifedipine 10 ¡‘≈≈‘°√—¡ „µâ≈‘Èπ √à«¡°—∫√—∫ª√–∑“π 20 ¡‘≈≈‘°√—¡

3. Nifedipine 20 ¡‘≈≈‘°√—¡ √—∫ª√–∑“π

·≈â«µ“¡¥â«¬ Nifedipine 10-20 ¡‘≈≈‘°√—¡ √—∫ª√–∑“π∑ÿ° 6-8 ™—Ë«‚¡ß

¢âÕÀâ“¡ ¿“«–§«“¡¥—π‚≈À‘µµË” (§«“¡¥—π‚≈À‘µµË”°«à“ 90/50 ¡¡.ª√Õ∑) À≈’°‡≈’Ë¬ß°“√„™â√à«¡°—∫

magnesium sulfate

º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ‰¥â·°à √âÕπ«Ÿ∫«“∫ ª«¥»’√…– ¡÷πßß §≈◊Ëπ‰ â §«“¡¥—π‚≈À‘µµË”™—Ë«¢≥–

º≈¢â“ß‡§’¬ßµàÕ∑“√° ¢≥–π’È¬—ß‰¡à¡’√“¬ß“π™—¥‡®π

ยากลม prostaglandin synthetase inhibitors4,5,15

°≈‰°°“√ÕÕ°ƒ∑∏‘Ï ¬—∫¬—Èß‡Õπ‰´¡å cyclooxygenase ≈¥‡Õπ‰´¡å prostaglandin synthetase ·≈–¢—¥¢«“ß

°“√‡ª≈’Ë¬π arachidonic acid ‡ªìπ prostaglandin ∑”„Àâ°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°≈¥≈ß ∑’Ë„™â∫àÕ¬ §◊Õ indomethacin

¬“µ—«Õ◊ËπÊ ‰¥â·°à sulindac ·≈– ketorolac28 πÕ°®“°π’È ¡’°“√»÷°…“¬“„π°≈ÿà¡ COX-2 inhibitors ‡™àπ celecoxib ·≈–

rofecoxib ‡π◊ËÕß®“°¡’º≈¢â“ß‡§’¬ßµàÕ¡“√¥“·≈–∑“√°πâÕ¬20-22

222


¢π“¥·≈–«‘∏’„™â

Indomethacin ‡√‘Ë¡¥â«¬°“√√—∫ª√–∑“π ¢π“¥ 50 ¡‘≈≈‘°√—¡ À√◊Õ ‡ÀπÁ∫∑«“√Àπ—° 50-100 ¡‘≈≈‘°√—¡

·≈â«µ“¡¥â«¬√—∫ª√–∑“π ¢π“¥ 25 ¡‘≈≈‘°√—¡ ∑ÿ° 4 ™—Ë«‚¡ß ‡ªìπ‡«≈“ 48 ™—Ë«‚¡ß

Ketorolac ‡√‘Ë¡¥â«¬°“√©’¥‡¢â“°≈â“¡‡π◊ÈÕ 60 ¡‘≈≈‘°√—¡ µ“¡¥â«¬ 30 ¡‘≈≈‘°√—¡ ∑ÿ° 6 ™—Ë«‚¡ß ‡ªìπ‡«≈“

48 ™—Ë«‚¡ß

Sulindac √—∫ª√–∑“π 200 ¡‘≈≈‘°√—¡ ∑ÿ° 12 ™—Ë«‚¡ß ‡ªìπ‡«≈“ 48 ™—Ë«‚¡ß

¬“∑ÿ°µ—«¥—ß°≈à“« §«√„™â‰¡à‡°‘π 48-72 ™—Ë«‚¡ß „π°“√µ—Èß§√√¿å∑’ËπâÕ¬°«à“À√◊Õ‡∑à“°—∫ 32 —ª¥“Àå ‡æ◊ËÕ

À≈’°‡≈’Ë¬ßº≈¢â“ß‡§’¬ßµàÕ∑“√°‡π◊ËÕß®“° ductus arteriosus ªî¥ ·≈–¿“«–πÈ”§√Ë”πâÕ¬

¢âÕÀâ“¡ ‚√§µ—∫«“¬À√◊Õ‰µ«“¬ ÀÕ∫À◊¥ ·º≈„π°√–‡æ“–Õ“À“√®“°°“√„™â¬“ non steroidal antii-

inflammatory drugs (NSAIDs) §«“¡º‘¥ª°µ‘¢Õß°“√·¢Áßµ—«¢Õß‡≈◊Õ¥ ¿“«–‡°≈Á¥‡≈◊Õ¥µË” À√◊Õ·æâ¬“ NSAIDs

º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ∑’Ëæ∫∫àÕ¬ ‰¥â·°à §≈◊Ëπ‰ â ·≈–· ∫√âÕπ∫√‘‡«≥Àπâ“Õ°

º≈¢â“ß‡§’¬ßµàÕ∑“√° À“°‰¥â√—∫¬“π“π‡°‘π‰ª À√◊Õ„™â¬“‡¡◊ËÕÕ“¬ÿ§√√¿å„°≈â§√∫°”Àπ¥Õ“®∑”„Àâ‡°‘¥º≈

‡ ’¬µàÕ∑“√° ‡™àπ indomethacin ∑”„Àâ‡°‘¥°“√ªî¥¢Õß ductus arteriosus ‡°‘¥¿“«–§«“¡¥—π‡≈◊Õ¥„πªÕ¥ Ÿß °“√

∑”ß“π¢Õß‰µ‡ª≈’Ë¬π·ª≈ß ∑”„Àâ‡°‘¥¿“«–πÈ”§√Ë”πâÕ¬ ¿“«–‡≈◊Õ¥ÕÕ°„π‚æ√ß ¡Õß ¿“«–≈”‰ â‡πà“‡ªóòÕ¬ ·≈–¿“«–

µ—«‡À≈◊Õß º≈¢â“ß‡§’¬ß¥—ß°≈à“« ¡—°‡°‘¥„π∑“√°∑’Ë¡“√¥“‰¥â√—∫¬“‡ªìπ√–¬–‡«≈“π“π ‰¥â√—∫¬“ª√‘¡“≥¡“° À√◊ÕÕ“¬ÿ

§√√¿å¡“°°«à“ 32 —ª¥“Àå à«π¬“ sulindac ¡’º≈¢â“ß‡§’¬ßµàÕ∑“√°πâÕ¬°«à“ °“√ªî¥¢Õß ductus arteriosus À“¬‰¥â

‡Õß¿“¬„π 24 ™—Ë«‚¡ßÀ≈—ßÀ¬ÿ¥¬“ à«π¿“«–πÈ”§√Ë”πâÕ¬ À“¬‰¥â¿“¬„π 96 ™—Ë«‚¡ßÀ≈—ßÀ¬ÿ¥¬“

Nitroglycerin4,5,15

°≈‰°°“√ÕÕ°ƒ∑∏‘Ï ‡ªìπ¬“∑’Ë≈¥°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°∑’Ë¡’ƒ∑∏‘Ï·√ß

¢π“¥·≈–«‘∏’„™â „™âªî¥º‘«Àπ—ß¢π“¥ 10-50 ¡‘≈≈‘°√—¡µàÕ«—π

º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ¿“«–§«“¡¥—π‚≈À‘µµË” ª«¥»’√…–

º≈¢â“ß‡§’¬ßµàÕ∑“√° Õ—µ√“À—«„®‡√Á«

Oxytocin antagonists4,5,15,23

°≈‰°°“√ÕÕ°ƒ∑∏‘Ï ‰ª·¬àß®—∫°—∫ oxytocin receptors ∑—Èß∑’Ë‡´≈≈å°≈â“¡‡π◊ÈÕ¡¥≈Ÿ° ·≈– decidua

¢π“¥·≈–«‘∏’„™â ‡√‘Ë¡À¬¥‡¢â“À≈Õ¥‡≈◊Õ¥¥”¢π“¥ 6.75 ¡‘≈≈‘°√—¡ µ“¡¥â«¬ 300 ‰¡‚§√°√—¡µàÕπ“∑’

‡ªìπ‡«≈“ 3 ™—Ë«‚¡ß ·≈–µ“¡¥â«¬¢π“¥ 100 ‰¡‚§√°√—¡µàÕπ“∑’ ‡ªìπ‡«≈“ 45 ™—Ë«‚¡ß

223


º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ æ∫«à“‰¡à¡’º≈µàÕ√–∫∫À—«„®·≈–À≈Õ¥‡≈◊Õ¥ √–∫∫À“¬„®À√◊Õ√–∫∫ª√– “∑

à«π°≈“ß º≈¢â“ß‡§’¬ß∑’Ëæ∫¡’‡≈Á°πâÕ¬ ‰¥â·°à Õ“‡®’¬π ª«¥»’√…– ‡®Á∫Àπâ“Õ° ·≈–ª«¥¢âÕ (dysgeusia)

º≈¢â“ß‡§’¬ßµàÕ∑“√° ªí®®ÿ∫—π¬—ß‰¡àæ∫º≈¢â“ß‡§’¬ß

®–‡ÀÁπ«à“¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°¡’À≈“¬™π‘¥ °“√‡≈◊Õ°«à“®–„™â¬“µ—«„¥„Àâæ‘®“√≥“‡ªìπ√“¬Ê

‚¥¬¥Ÿ®“°Õ“¬ÿ§√√¿å ªí®®—¬¥â“π¡“√¥“·≈–∑“√° √«¡∑—Èßº≈¢â“ß‡§’¬ß13 ‚¥¬°àÕπ∑’Ë®–„™â¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß

¡¥≈Ÿ°5,16 §«√ªØ‘∫—µ‘¥—ßπ’È

1. µ√«®¬◊π¬—π«à“¡’¿“«–°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ ‚¥¬æ∫°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°∑’Ë ¡Ë”‡ ¡Õ ·≈–

°“√‡ª≈’Ë¬π·ª≈ß¢Õßª“°¡¥≈Ÿ° (¡’°“√‡ªî¥À√◊Õ¡’°“√∫“ßµ—«) ‚¥¬∑’Ëª“°¡¥≈Ÿ°‡ªî¥πâÕ¬°«à“ 3 ‡´πµ‘‡¡µ√

2. µ√«®¬◊π¬—πÕ“¬ÿ§√√¿å„Àâ·πàπÕπ

3. §«√∫—π∑÷°¢âÕ¡Ÿ≈°àÕπ„Àâ°“√√—°…“ ¥—ßπ’È

3.1 ¿“«–¢Õßª“°¡¥≈Ÿ°

3.2 ¿“«–°“√µ—Èß§√√¿å ·≈–∑“√°„π§√√¿å

3.3 µ√«®ªí “«– ‡æ◊ËÕ¥Ÿ«à“‰¡à¡’°“√µ‘¥‡™◊ÈÕ„π∑“ß‡¥‘πªí “«–

3.4 §âπÀ“¿“«–°“√µ‘¥‡™◊ÈÕ GBS

4. √–À«à“ß„Àâ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° §«√∫—π∑÷°¢âÕ¡Ÿ≈ ¥—ßπ’È

4.1 °“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° ·≈–Õ—µ√“À—«„®¢Õß∑“√°„π§√√¿å

4.2 ª√‘¡“≥ “√πÈ” ·≈–ªí “«–

4.3 ‡ΩÑ“ —ß‡°µÕ“°“√ ·≈–Õ“°“√· ¥ß¢Õß¿“«–·∑√°´âÕπ

ยาทนำมาใชในภาควชาสตศาสตร-นรเวชวทยา คณะแพทยศาสตร จฬาลงกรณมหาวทยาลย

1. Terbutaline º ¡¬“ 5 ¡‘≈≈‘°√—¡„π 5% dextrose water 500 ¡‘≈≈‘≈‘µ√ ‡√‘Ë¡„Àâ¬“‚¥¬À¬¥‡¢â“

À≈Õ¥‡≈◊Õ¥¥” ¢π“¥ 10 ‰¡‚§√°√—¡µàÕπ“∑’ ‡æ‘Ë¡¢π“¥¬“§√—Èß≈– 5 ‰¡‚§√°√—¡µàÕπ“∑’ ∑ÿ°Ê 10 π“∑’ ®π¡¥≈Ÿ°À¬ÿ¥

À¥√—¥µ—« À≈—ß®“°∑’Ë°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°À“¬‰ª „Àâ§ß¢π“¥µË”∑’Ë ÿ¥‡ªìπ‡«≈“ 12 ™—Ë«‚¡ß ®÷ß‡ª≈’Ë¬π‡ªìπ ¢π“¥

0.25 ¡‘≈≈‘°√—¡ ©’¥‡¢â“„µâº‘«Àπ—ß∑ÿ° 4 ™—Ë«‚¡ß

2. Nifedipine √—∫ª√–∑“π ¢π“¥ 5-10 ¡‘≈≈‘°√—¡ ·≈â«µ“¡¥â«¬¢π“¥ 5-10 ¡‘≈≈‘°√—¡ ∑ÿ° 6-8 ™—Ë«‚¡ß

®“°ª√– ∫°“√≥å¢ÕßºŸâπ‘æπ∏å °“√„™â¬“ Nifedipine ¢π“¥ 5 ¡‘≈≈‘°√—¡ √—∫ª√–∑“π∑ÿ° 6 ™—Ë«‚¡ß ‰¥âº≈¥’ “¡“√∂

¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°‰¥â 100% ∂â“¥Ÿº≈°“√√—°…“∑’Ë 48 ™—Ë«‚¡ß ·≈–æ∫º≈¢â“ß‡§’¬ß ‡™àπ ¡÷πßß (33%) ‡≈Á°πâÕ¬

3. Indomethacin ‡√‘Ë¡¥â«¬°“√√—∫ª√–∑“π ¢π“¥ 50 ¡‘≈≈‘°√—¡ ·≈â«µ“¡¥â«¬¢π“¥ 25 ¡‘≈≈‘°√—¡

∑ÿ° 6 ™—Ë«‚¡ß ‡ªìπ‡«≈“ 48 ™—Ë«‚¡ß

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4. Atosiban ‡√‘Ë¡À¬¥‡¢â“À≈Õ¥‡≈◊Õ¥¥” ¢π“¥ 6.75 ¡‘≈≈‘°√—¡ µ“¡¥â«¬¢π“¥ 300 ‰¡‚§√°√—¡µàÕπ“∑’

‡ªìπ‡«≈“ 3 ™—Ë«‚¡ß ·≈–µ“¡¥â«¬¢π“¥ 100 ‰¡‚§√°√—¡µàÕπ“∑’ ‡ªìπ‡«≈“ 45 ™—Ë«‚¡ß

5. Salbutamol °“√„™â¬“¢π“¥ Ÿß„π√Ÿª·∫∫√—∫ª√–∑“π ¢π“¥ 8 ¡‘≈≈‘°√—¡ ∑ÿ° 6 ™—Ë«‚¡ß ‡æ◊ËÕ¬—∫¬—Èß°“√

‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥‰¥âº≈ 60%18 Õ“®‡ªìπ∑“ß‡≈◊Õ°Àπ÷Ëß„π‚√ßæ¬“∫“≈∑’Ë‰¡à “¡“√∂∫√‘À“√¬“„π√Ÿª·∫∫Õ◊Ëπ

6. Magnesium sulfate ‡√‘Ë¡„Àâ¬“∑“ßÀ≈Õ¥‡≈◊Õ¥¥”¢π“¥ 5 °√—¡ ™â“Ê „π‡«≈“ 20 π“∑’ µ“¡¥â«¬°“√À¬¥

‡¢â“À≈Õ¥‡≈◊Õ¥¥”„πÕ—µ√“ 1-4 °√—¡µàÕ™—Ë«‚¡ß °“√ª√—∫¢π“¥¢Õß¬“„Àâæ‘®“√≥“µ“¡°“√À¬ÿ¥À¥√—¥µ—«¢Õß¡¥≈Ÿ° ·≈–

º≈¢â“ß‡§’¬ßµàÕ¡“√¥“ ·≈–°“√∑”ß“π¢Õß‰µ

การใหยายบยงการหดรดตวของมดลกตอเนองหลงใหการรกษาชวงแรก (maintenance therapy after acute tocolysis)

®“°°“√»÷°…“æ∫«à“ °“√„Àâ¬“µàÕ‡π◊ËÕß‰¡à™à«¬≈¥Õ—µ√“°“√‡°‘¥°“√°≈—∫‡ªìπ´È”¢Õß¿“«–‡®Á∫§√√¿å§≈Õ¥

·≈–°“√§≈Õ¥°àÕπ°”Àπ¥Õ¬à“ß¡’π—¬ ”§—≠ ‰¡à‡æ‘Ë¡§à“‡©≈’Ë¬¢ÕßÕ“¬ÿ§√√¿å‡¡◊ËÕ§≈Õ¥À√◊Õ¬◊¥‡«≈“°“√§≈Õ¥ÕÕ°‰ª14

การใหยายบยงการหดรดตวของมดลกซำเมอมภาวะเจบครรภคลอด กอนกำหนดกลบเปนซำ

∫∑∫“∑¢Õß°“√„Àâ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°´È”‡¡◊ËÕ¡’¿“«–‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ À≈—ß„Àâ¬“

¬—∫¬—Èß§√—Èß·√°¬—ß‰¡à∑√“∫ ‡π◊ËÕß®“°·π–π”„Àâ„™â¬“§Õ√åµ‘‚§ ‡µ’¬√Õ¬¥å√à«¡°—∫¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°·∫∫

§√—Èß‡¥’¬« ¥—ßπ—Èπ ª√–‚¬™πå¢Õß°“√„Àâ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°´È”®÷ß‰¡à·πà™—¥ ∂â“®–„Àâ°Á‡æ’¬ß«—µ∂ÿª√– ß§å∑’Ë

µâÕß°“√π” àß µ√’µ—Èß§√√¿å‰ª√—°…“„π‚√ßæ¬“∫“≈∑’Ë¡’§«“¡ “¡“√∂¥â“π°“√¥Ÿ·≈∑“√°‡°‘¥°àÕπ°”Àπ¥14

‚¥¬ √ÿª·π«∑“ß°“√¥Ÿ·≈√—°…“¿“«°“√≥å‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥ 5 ¡’¥—ßπ’È

1. µ√«®æ‘ Ÿ®πå«à“¡’¿“«–°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥®√‘ß (¡’°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°Õ¬à“ß ¡Ë”‡ ¡Õ

√à«¡°—∫°“√‡ª≈’Ë¬π·ª≈ß¢Õßª“°¡¥≈Ÿ°)

2. ¬◊π¬—πÕ“¬ÿ§√√¿å®“°ª√–«—µ‘ °“√µ√«®√à“ß°“¬ ·≈–°“√µ√«®¥â«¬Õ—≈µ√“´“«π¥å

3. µ√«®¥Ÿ¿“«–¢Õß¡“√¥“·≈–∑“√°„π§√√¿å ·≈–À“ “‡Àµÿ¢Õß¿“«–°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ°”Àπ¥

4. æ‘®“√≥“„Àâ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° À“°Õ“¬ÿ§√√¿åπâÕ¬°«à“ 34 —ª¥“Àå (ª“°¡¥≈Ÿ°‡ªî¥

πâÕ¬°«à“ 3 ‡´πµ‘‡¡µ√ ·≈–∫“ßµ—«πâÕ¬°«à“√âÕ¬≈– 80) °“√‡≈◊Õ°™π‘¥¢Õß¬“„Àâæ‘®“√≥“µ“¡§«“¡‡À¡“– ¡¢Õß

ºŸâªÉ«¬ ¢âÕ∫àß™’È·≈–¢âÕÀâ“¡ À“°Õ“¬ÿ§√√¿å¡“°°«à“À√◊Õ‡∑à“°—∫ 34 —ª¥“Àå °“√æ‘®“√≥“„Àâ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß

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5. „Àâ¬“§Õ√åµ‘‚§ ‡µ’¬√Õ¬¥å „π∑“√°Õ“¬ÿ§√√¿å 24-34 —ª¥“Àå

225


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7. §«√∑”°“√µ√«®∫—π∑÷° —≠≠“≥™’æ °“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° Õ—µ√“À—«„®¢Õß∑“√° ·≈–‡ΩÑ“√–«—ß¿“«–

·∑√°´âÕπ

บทสรป

¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ° ‡ªìπ¬“™π‘¥Àπ÷Ëß∑’Ë„™â„π°“√¥Ÿ·≈√—°…“¿“«–°“√‡®Á∫§√√¿å§≈Õ¥°àÕπ

°”Àπ¥ «—µ∂ÿª√– ß§å §◊Õ ¬◊¥√–¬–‡«≈“°“√§≈Õ¥ÕÕ°‰ªÕ¬à“ßπâÕ¬ 48 ™—Ë«‚¡ß ‡æ◊ËÕ¡ÿàßÀ«—ß„Àâ¬“§Õ√åµ‘‚§ ‡µ’¬√Õ¬¥å

ÕÕ°ƒ∑∏‘Ï°√–µÿâπ°“√‡®√‘≠¢ÕßªÕ¥∑“√° ¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°¡’ 6 °≈ÿà¡ ´÷Ëß‰¥âº≈¥’‰¡à·µ°µà“ß°—π

·µà·µ°µà“ß°—π„π¥â“πº≈¢â“ß‡§’¬ß ¥—ßπ—Èπ°“√‡≈◊Õ°„™â¬“°≈ÿà¡„¥ „Àâæ‘®“√≥“µ“¡§«“¡‡À¡“– ¡¢Õß µ√’µ—Èß§√√¿å

·µà≈–√“¬ Õ“¬ÿ§√√¿å ¢âÕÀâ“¡·≈–º≈¢â“ß‡§’¬ß¢Õß¬“ ·≈–§«√‡ΩÑ“√–«—ßº≈¢â“ß‡§’¬ß¢Õß¬“¬—∫¬—Èß°“√À¥√—¥µ—«¢Õß¡¥≈Ÿ°

เอกสารอางอง

1. Svigos JM, Robinson JS, Vigneswaran R. Threatened and actual preterm labor including mode of

delivery. In: James DK, Steer PJ, Weiner CP, Gonik B, editors. High risk pregnancy: management

options. 2nd ed. Philadelphia: W.B. Saunders; 1999. p. 999-1013.

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22nd ed. New York: McGraw-Hill; 2004.

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4. Goldenberg RL. The management of preterm labor. Obstet Gynecol 2002; 100: 1020-37.

5. «√æß»å ¿Ÿàæß»å. °“√‡®Á∫§√√¿å·≈–°“√§≈Õ¥°àÕπ°”Àπ¥. „π: ‡¬◊ÈÕπ µ—ππ‘√—π¥√å, «√æß»å ¿Ÿàæß»å, ∫√√≥“∏‘°“√.

‡«™»“ µ√å¡“√¥“·≈–∑“√°„π§√√¿å. π‘æπ∏å·≈–‡√’¬∫‡√’¬ß§√—Èß∑’Ë 2. °√ÿß‡∑æœ: æ‘¡æå¥’; 2551. Àπâ“ 41-60.

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Fetal Medicine. 5th ed. Philadelphia: W.B. Saunders; 2003. p. 623-61.

7. Pschirrer ER, Monga M. Risk factors for preterm labor. Clin Obstet Gynecol 2000; 43(4): 727-34.

8. Weismiller DG. Preterm labor. Am Fam Physician 1999; 59(3): 593-602.

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Gynecol Obstet 2007; 276: 167-70.

11. Blanco JD. Clinical problem of preterm labor. Clin Obstet Gynecol 2000; 43: 713-6.

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859-66.

13. «√æß»å ¿Ÿàæß»å. Preterm labor: management aspect. „π: Excellent care for womenûs health. °√ÿß‡∑æœ:

√“™«‘∑¬“≈—¬ Ÿµ‘π√’·æ∑¬å·Ààßª√–‡∑»‰∑¬; 2549. Àπâ“ 55-72.

14. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologist. Number 43,

May 2003. Management of preterm labor. Obstet Gynecol 2003; 101: 1039-47.

15. Hearne AE, Nagey DA. Therapeutic agents in preterm labor: tocolytic agents. Clin Obstet Gynecol

2000; 43: 787-801.

16. ACOG criteria set. Quality evaluation and improvement in practice. Tocolysis. Number 34, June 1998

(replaces No. 31, February 1998). Committee on Quality Assessment. American College of Obstetricians

and Gynecologists. Int J Gynaecol Obstet 1998; 63: 85-6.

17. Simhan HN, Caritis SN. Prevention of preterm delivery. N Engl J Med 2007; 357: 477-87.

18. Phupong V, Charakorn C, Charoenvidhya D. Oral salbutamol for treatment of preterm labor. J Med

Assoc Thai 2004; 87: 1012-6.

19. Crowther CA, Hiller JE, Doyle LW. Magnesium sulphate for preventing preterm birth in threatened

preterm labour. Cochrane Database Syst Rev 2002: CD001060.

20. Phupong V. Role of COX-2 inhibitor in obstetrics. Chula Med J 2004; 48: 111-31.

21. Stika CS, Gross GA, Leguizamon G, Gerber S, Levy R, Mathur A, et al. A prospective randomized

safety trial of celecoxib for treatment of preterm labor. Am J Obstet Gynecol 2002; 187: 653-60.

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preterm labor: a randomized trial. Obstet Gynecol 2004; 103: 923-30.

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