Pcu Manual Ncd

8/12/2019 Pcu Manual Ncd

1/134


2/134

9,750

2554


3/134


4/134

2 17 1. 1) 2) .. 3) .. 4).. 5) 6)

7) .. 8) .. 9) 2.1) 2) 3) .. 4) .. 5) 6)

.. 7) : 8)


5/134

-

1 : 2 : 3 :

4 : 5 : 6 : 7 :

1

3

6

11

15

26

30

42


6/134

53

55

57

63

71

118

1 :

2 : 3 :

4 : 5 :

-

()


7/134

-

1

2

3

4

5 ()

18

6

7 8

13

17

37

38

64

72

7677


8/134

14

30

69

70

98

99

100

101

102

102

103

103

-

1

2

3

4

5 6 7

8 9 101112


9/134

1


10/134

2


11/134

3

2.8.. 2543 4.4.. 2573 .. 2543 171 366 .. 2573

Inter ASIA .. 2543 35 9.6 2.4 (, 2548)

1 -


12/134

4

(Macrovascular disease) (Microvascular disease)

(Morbidity )(Mortality) (Disability Adjusted Life Year : DALY) 3 DALY

(7) 5 DALY(3)

3.5 2


13/134

5

2


14/134

6

2

1 (:IDDM)

2 (: NIDDM)

: () (Pancreas)

2


15/134

7

11

:1.

2.

(Hyperglycemia)

3.

4.

5.

2

2 90 2 2

3


16/134

8

1. 2 Insulin resistance 2

2

2. 2 (Postprandial hyperglycemia)

3.


17/134

9

2 2 (

) -

1.(Diabetic retinopathy)

Endothelium

Basement membrane

Basement membrane Macula Blurredvision Retina

2


18/134

10

2.(Diabetic nephropathy)Glomeruli

Nephron Albumin Filtrate Proximaltubule Renal failure

3. (Diabeticneuropathy)

4. (Coronary vascular disease)

5. (Cerebrovascular disease)

6.(Peripheral vascular

disease)7.(Diabetic ulcer)8.


19/134

11

3 .1

()1. 8

(Fasting plasma glucose FPG) 126 /2

2.

(Random

plasma glucose) 200 / ( )

3.2

3


20/134

12

1. 35 2. BMI > 25 /2

36 (90 ) 32 (80 ) -

3. 4. 5. (Triglyceride > 250

/ Cholesterol < 35 /)

6.

4


21/134

13

1

1.3

2.

1. 1

2.

1.1

2.

3.

1.

2.

Normal

Impaired glucose

tolerance

(IGT)

()

()

FPG < 110 mg/dl

FPG 110 -125 mg/dl

> 126 mg/dl

> 200 mg/dl

Category


22/134

14

11111

35 ()

.. (8 )

FBS 126 mg%

FBS>200 mg%

3 1

< 126 mg/dl > 126 mg/dl1.(/)- /(DM//Stroke)/

2. (//)

1.(/)- /(DM//Stroke)/

2. (:///)

/

(

)

Stroke(

)

DM DM

1

1.

2.(/)- (DM//Stroke)

2. (:///)

Stroke3 1. 2. 3. 3


23/134

15

4

9 9

1.5

2.

3.


24/134

16

4.5.6.7.8.9.

5

1

2 (body mass index, BMI

=

- 100

-= - 100 - (10% )


25/134

17

() < 23

() 23-24.9 () 25

(./) = ()

()2

2


26/134

18

9

: 5

5 1.2.

3.


27/134

19

4.(dietary fiber)

5.

:

50 - 60

:


28/134

20

:

(high biological value protein) 20


29/134

21

12 - 15

lean meat

1 (50 )

250 2 - 3

- 3

:

87

80 (casein)

(whole milk)


30/134

22

2 - 3 (low fat milk) (skim milk)1 - 2

:

A , D , E K 30

(saturated fattyacid)

3

1.(monounsaturated fatty acid)

2.(polyunsaturated fatty acid)


31/134


32/134

24

5.6.

7.

(nonnutritive sweeteners)


33/134

25

(aspartame) (low calories nutritivesweeteners) 1 4 200

2 (asparticacid) (phenylalanine)

(saccharin) 2

300 (cyclamate)


34/134

26

(exercise) (physical activity) (sport)

30 - 45

(general physical fitness)

5


35/134

27

- 3


36/134

28

(exercise training)

(intensity) (frequency) (duration) (warm up) (cool down)

3 30

3 - 5


37/134


38/134

30

6

2222 2

DM

< 140 mg/dl > 140 mg/dl

3 1

4-8

80-120 mg/dl

1. /

/2. (/)- (HT/DM//Stroke///)3. (:///)

1. /

//2.(/)- (HT/DM//Stroke///)3. (:///)

1. > 200 mg/dl 1 2. < 80 mg/dl 1 3. > 140 mg/dl 2 4. 80-140 mg/dl 1() * 80-120 mg/dl 1 () 1


39/134

31

1.

Glucocorticoid

-


40/134

32

4

2.

-Body Mass Index (BMI)

-(V/A)(

)

( )( )

3. Fasting plasma glucose

Total cholesterol, Triglyceride, HDL-cholesterol Serum creatinine

(Urinalysis) EKG (

10 )


41/134

33

4.

()

4

2

Lipid profiles

1 - 2

2-3


42/134


43/134

35

1.

3 1.1

(Insulin secretagogue) Sulfonylurea

Glipizida , Glibenclamide1.2 (Insulin sensitizer)

Biguanide Metformin

1.3 Alpha - glucosidase (Alpha- glucosidase inhibitor) Acarbose

2.

Gastric hormones


44/134

36

2.1 (Short-acting insulin) Regular insulin (RI) 30-60 2-4 4-6

2.2 (Intermediate-acting insulin) Protamine stabilized insulin (NPH)

Lente 2 10 - 16

3

2-8


45/134

37

3

2.5 - 20

/(1 - 2 /)2.5 - 20

/(1 - 2 /)

30

500 - 3,000

/

(1 - 3 /)150 - 300

/(3 /)

Beta cell

Insulin

Minidiab

Daonil

Glucophage

Glucobay

Glipizide

Glibenclamide

Metformin

Acarbose

1.Insulin

secretagogue- Sulfonylurea

short acting

Long acting

2.Insulin

sensitizer

- Biguanide

3.Glucosidase

Inhibitor


46/134

38

4

..

. .

Short acting

Regular (Solution)

Intermediate acting

NPH (Isophane)

Lente (Insulin zinc suspension)

Humalin R, Actrapid

Humalin N, Insulatard

Monotard


47/134

39

1.

2.

3.

4.

5.

(home ward)


48/134

40

1. :1.1

1.2

1.3

2. :2.1

. ()

2.2

.


49/134

41

2.3 Diabetic chart

3. :3.1

3.2


50/134

42

7

1.

2.

1.

2.

1.

2.

3.

1.2.

1.

2.


51/134

43

1.

2.

1.

2.

1.

1.

2.


52/134

44

3.

1.

2./

3.

1.2.3.

4.5.


53/134

45

3.- - /- - -

1.

2.

3.

4.

1.

2.

3.


54/134

46

4.

5.(.)

1.

2.

1.

2.

/

3.

1.2.

1.

2.

3.


55/134

47

1.

1.

2.

3.

1.

1.2.

3.


56/134

48

6.

1.

2.

3.

1.

2.


57/134

49

1./

1.

2.

3.


58/134

50

1. 2.

()

3.

4.

5.


59/134

51

1. . . :

; 2548.2. . .

: ; 2548.3.

.

. : (1977) . 2551.

4. / 40 2550. 6 2551

http://www.kuntaluk.com/kuntaluk1/uploadfile/20070323094842.doc


60/134

52

5. , . . :; 2532 :32 - 73

6. American Diabetes Association : Clinical Practice

recommendation 2003. Physical activity/exercise and

diabetes mellitus. Diabetes Care 2003 ; 26 (suppl 1) :

S73-7


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62/134

54


63/134

55

.. 2541 - 2545

3.3 - 5.1 13 - 60 1360

33

60

1 -


64/134

56

1.

2.

3.


65/134

57

2.1

()

2


66/134


67/134

59

()

2.2.2.2

2.2.2.3

2.2.2.4

50


68/134

60

2.2.3 (EnvironmentRisk Factors)

2.2.3.1

2.2.3.2

2.2.3.3 130

140 100


69/134

61

2.2.4. (Dietary RiskFactors)

2.2.4.1 (Sodium)

2.2.4.2 (Lipids)

2.2.4.3 (Alcohol)

blood cortisol


70/134

62

catecholamine renin-angiotensinantidiuretic hormoneAlcohol withdrawal Adrenergic hormone 10

2.2.4.4

2.2.4.5

1 5 30 - 60

2


71/134

63

3

Hypertension () 140/90

Isolated systolic hypertension

140

90

3.1


72/134

64

5 ()

- 18

1. 1 2.

3. /

1. 6 2. 3.

1. 2-3

2.

3.

1. /

2. 3.

Optimal -

normal

()

High normal

()

Grade 1Hypertension

(Mild)

()

Grade 2

(Moderate)

()Grade 3

()

180

Category SBP

/

/

/

/

110

SBP - Systolic Blood Pressure; DBP - Diastolic Blood Pressure; SBP DBP Isolated Systolic Hypertension SBP

DBP


73/134

65

3.2

3.2.1

30

5 2

3.2.2 Digital

Arm cuff(Bladder) 80 Arm cuff 12 - 13 . X 35 .

3.2.3 3.2.3.1 Arm cuff

2 - 3 Brachial artery


74/134

66

3.2.3.2 SBP (Rubber bulb)Brachial artery 2-3 / SBP

3.2.3.3

Stethoscope Brachial artery SBP 20 - 30 (Korotkoff I)SBP (Korotkoff V)DBP

3.2.3.4 2 1-2 + 5 2 5 3 + 5

3.2.3.5 2 35 (Coarctation of aorta)


75/134

67

1 SBP SBP 20 Orthostatic hypotensionOrthostatic hypotension SBPSBP

3.3 (Automatic blood pressure measurement device)

3.3.1 ()3.3.2

3.3.3 3

3.3.4

Sphygmomanometer 5 135/85


76/134

68

3.3.5 Isolatedoffice hypertension (White coat hypertension)

Cuff

Cuff -

Diastolic Bias


77/134

69

33 33 3

18 ()

BP < 120-129/80-84

mmHg

BP 130/85-

140/90 mmHg

BP >140/90

mmHg

BP > 140/90 mmHg

+BP > 160/110mmHg

1 2-3 6

> 140/90< 140/90

/

(

)

Stroke

1.(/)- /(HT//Stroke)/

2. (//)

1.(/)/(HT//Stroke)/2.

(: ///)

HT

6

HT

1. 2.

Stroke 3 1. 2. 3. 3

1.2.(/

)- /(HT//Stroke)/2. (:///)


78/134

70

4 44 44

: ***

HT

2-3 1

< 140/90 mmHg< 130/80 mmHg

1.///

2.(/)(HT/DM//Stroke/)3. (: ///)

* ()1. > 240 mg/dl TG > 160

2. BMI > 25, > 36 ,> 32 3. DM///Stroke/4. ()5. > 55

1. > 180/110 mmHg 2. > 160/100 mmHg 2 3. > 140/90 mmHg 3 4. < 140/90 mmHg 1() * < 140/90 mmHg1() 6


79/134

71

4

4.1

( 6)


80/134

72

5 - 20 10

8 - 14

2 - 8

4 - 9

2 - 4

(Body massindex) = 18.5 - 24.9 /

2 (2 2 30 3

--

SBP

6


81/134

73

4.2. 6

Diuretics , Beta-blockers , Calcium antagonists, ACE inhibitors,

Angiotensin II antagonists alpha-adrenergic blockers( 3) Diuretics Beta-blockers Calcium antagonists ACE inhibitors Alpha-adrenergic blockers Angiotensin II antagonists

4.2.1

1

2.

()


82/134

74

4.2.2

4.2.2.1 Diuretics stroke

Hydrochlorothiazide 25

Systolic hypertension

4.2.2.2 Beta - blockers Diureticsdihydropyridine calcium antagonists

Atenolol 25 - 100 /1


83/134

75

4.2.2.3 ACE inhibitors 1

angioedema Enarapril2.5 - 40 /

4.2.2.4 Calcium antagonists

Stroke Systolic

hypertension Amlodipine 10 / ? - 1


84/134

76

7

-

-

2

Diuretics

Beta-Blockers

ACE Inhibitors

C a l c i u m

Antagonists


- Angina (

)

- (Tachyarrhythmias)

Angina


Heart block

Heart block


85/134

77

8

CHF

Withdrawal syndrome

Hepatotoxicity

Depression

Active peptic ulcer

congestive heart failure

ACE inhibitors,

ARBs

- blocker

Diuretic

Pregnancy

Bilateral renal

artery stenosis

Hyperkalemia

A-V (grade 2 3)

block

Asthma

Obstructive

airway disease

Peripheral

artery disease

Gout

- blockers

Clonidine

Methyldopa

Reserpine

CCBs

HCTZ (25 )


86/134


87/134

79

130/80 DM ,CKD), > 160/110 , BP < 90/60

Pulse < 60 /

1. 2.

, ,,, ,-

1. 2.

1.

2.

1. , ,

,

2. :


88/134

80

4.3.2 1

1. Fasting plasma glucose

2. Serum total cholesterol, HDL-C, LDL-C,

triglyceride

3. Serum creatinine

4. Serum uric acid

5. Serum potassium

6. Hemoglobin hematocrit7. Urinalysis (dipstick testurine sediment)8. Electrocardiogram

4.4

4.4.1 /4.4.1.1


89/134

81

/

4.4.1.2

4.4.1.3

4.4.1.4

4.4.1.5

4.4.1.6


90/134

82

4.4.1.7 -3

4.4.1.8

4.4.2 4.4.2.1

4.4.2.2

4.4.2.3

4.4.2.4 4.4.2.5


91/134

83

4.4.2.6

4.4.3

1)

2)

"" ""3)

4)

5) 6) 7)


92/134

84

8)

9)4.4.4

4.4.4.1

4.4.4.2


93/134

85

4.4.4.3

4.4.4.4

4.4.4.5

4.4.4.6

4.4.5


94/134

86

4.4.6 8-10


95/134

87

1-2

4.4.7

1.2.


96/134

88

3.4.

4.4.7.1 1)

90


97/134

89

2)

4.4.7.2

1) 2)

3) 2 4)


98/134

90

4.4.7.3


99/134

91

4.4.8

4.4.8.1 (Flaccid Stage)

1)


100/134

92

2)


101/134

93

(Shoulder Subluxation)

4.4.8.2 (Spastic Stage)


102/134


103/134

95

1)

2)

3)

4)

5)


104/134

96

4.4.9

4.4.9.1

1)

(Hemiplegia) (Paraplegia/ Quadriplegia)


105/134

97

2)

3)

4.4.9.2

1)

1

3 1 : 12 6 1 : 20 1.50


106/134

98

1.80

2

5

1.2 1.8

5

12


107/134

99

6

2) -

0.85 -.090 -

1/2

0.45


108/134

100

2

0.60

7


109/134

101

3) 0.85 -

0.90 16 - 19

85

8


110/134

102

9

10


111/134

103

11

12


112/134

104

4)

0.30 - 1.2

85 90 50

4.4.10 4.4.10.11)


113/134

105

1)45

2)

3)()


114/134

106

2)

1) 45


115/134

107

2)

3)

4)


116/134

108

4.4.10.21)

2) 30


117/134

109

3)


118/134

110

4.4.10.3

4.4.10.4-


119/134

111

4.4.11 10-20 2

4.4.11.1

1.

2. 3. 4.

6.

5.


120/134

112

1.

2. 3.

4.

1.

2. 3.

4.

90


121/134

113

1. 2.

3.

1.

2. 3.

4.


122/134

114

/

1.2.

3.

1.2.


123/134

115

4.4.11.2

4.4.11.3

1.

2. 3.

4.

1.

2.3.

4.


124/134

116

4.4.11.4

1. 2.3.

1.

2.

3.

4.


125/134

117

1. 2.


126/134

118

5

1.

2.

1.

2.

1.

2.

3.

1.2.

1.

2.


127/134

119

1.

2.

1.

2.

1.

1.

2.


128/134

120

3.

4.

(.)

1.

2./

3.

1.

2./

3.

1.

2.3.

4.5.

1.

2.3.


129/134

121

1.

2.

3.

4.

1.

2.

3.

1.

2.

3.

1.2.

3.


130/134


131/134

123

1.

1. /

1.

1.

2.


132/134

124

1. 2.

()

3.

4.

5.


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125

1. . .

: ;2532.2. . 1999 WHO-ISH guidelines for the

management of hypertension. .2542; 12: 9-20.3. .

. 15 2552.http://www.thaihypertension.org/hypertensiondetail.php?

n_id=16

4. . 2547.

.. 15 2551

http://epid.moph.go.th/Homepage_Annual46/WESR47/

Group9/Group_9_6.html

5. Guidelines Sub-committee. (1999).WHO: 1999 guidelinesfor the management of hypertension. J Hypertens, 17,

151-185. Retrieved June 28, 1999 from

http://www.who.int/ncd/cvd/HT-Guide.html


134/134

6. Moser, M. (1999). A critique of the World Health

Organization: International Society of Hypertension

guidelines for the management of hypertension.

Cardiovascular Reviews & Reports,20, 1-4. Retrieved June 28,

1999 from

http://www.medscape.com/Medscape/features/article/

1999/mc0202.02.mose/

7. 1999 WHO-ISH guidelines for the management of

hypertension: A summary of key points. Retrieved June 28,

1999 from http://acvc.com/who-ish.cfm.

8. http://pni.go.th/

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