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1Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
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WWW. RCST.OR.TH
2 “√®“°ª√–∏“π√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
4 √“¬π“¡§≥–°√√¡°“√∫√‘À“√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬ ¡—¬∑’Ë 22 «“√– 2560-2562
7 °“√ª√–™ÿ¡«‘™“°“√ à«π¿Ÿ¡‘¿“§ ≥ ¡À“«‘∑¬“≈—¬ ߢ≈“π§√‘π∑√å
8 æ√–Õ—®©√‘¬¿“æ¢Õßæ√–∫“∑ ¡‡¥Á®æ√–ª√¡‘π∑√¡À“¿Ÿ¡‘æ≈Õ¥ÿ≈¬‡¥™ ¡À‘μ≈“∏‘‡∫»√√“¡“∏‘∫¥’
®—°√’πƒ∫¥‘π∑√ ¬“¡‘π∑√“∏‘√“™ ∫√¡π“∂∫æ‘μ√
9 »μ«√√…∑’Ë 21 „§√‡À¡“–∑’Ë®–√—∫Àπâ“∑’Ë¥Ÿ·≈ºŸâªÉ«¬«‘°ƒμ¡“°∑’Ë ÿ¥»“ μ√“®“√¬å‡°’¬√쑧ÿ≥ 𓬷æ∑¬å®Õ¡®—°√ ®—π∑√ °ÿ≈
13 Thailand 4.0 : Quality Improvement in Surgery Towards Thailand 4.0æ≈‚∑ ».§≈‘𑰠𓬷æ∑¬å≥√ߧå √Õ¥«√√≥–
17 Õ¬“°‡ÀÁπ RCST Membership Profileæ≈μ”√«®μ√’ 𓬷æ∑¬å™ÿ¡»—°¥‘Ï æƒ°…“æß…å
21 §«“¡ª≈Õ¥¿—¬¢ÕߺŸâªÉ«¬ À—«„®À≈—°¢Õß°“√ºà“μ—¥√—°…“»“ μ√“®“√¬å‡°’¬√쑧ÿ≥ 𓬷æ∑¬å»ÿ¿°√ ‚√®ππ‘π∑√å
24 2P Safety çPatient Safety Goals: SIMPLE Thailand 2017é𓬷æ∑¬åæ√‡∑æ ‡ª√¡‚¬∏‘π
29 ¢âÕ¡Ÿ≈ ¡“™‘°√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
30 «—𠔧—≠‡¥◊Õπ°—𬓬π 2560 - °ÿ¡¿“æ—π∏å 2561
33 ∫∑∫√√≥“∏‘°“√
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3Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
·≈–§√—Èß∑’Ë 2 √–À«à“ß«—π∑’Ë 21-22 °—𬓬π 2560
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5Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
°√√¡°“√°≈“ß °√√¡°“√°≈“ß °√√¡°“√°≈“ß
𓬷æ∑¬å∏—≠‡¥™ π‘¡¡“π«ÿ≤‘æß…å 𓬷æ∑¬åæ√™—¬ ‚Õ‡®√‘≠√—μπå 𓬷æ∑¬å»ÿ¿°√ ‚√®ππ‘π∑√å
ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬å∑—Ë«‰ª ºŸâ·∑π°≈ÿà¡°ÿ¡“√»—≈¬·æ∑¬å ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬åμ°·μàß
𓬷æ∑¬å∑√ß™—¬ ‘¡–‚√®πå 𓬷æ∑¬å¡π«—≤πå ‡ß‘π©Ë” 𓬷æ∑¬å»‘√™—¬ ®‘π¥“√—°…å
ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬å∑√«ßÕ° ºŸâ·∑π°≈ÿࡪ√– “∑»—≈¬·æ∑¬å ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬å ¬Ÿ‚√«‘∑¬“
𓬷æ∑¬å ¡¿æ æ√–∏“π’ 𓬷æ∑¬å¬Õ¥√—° ª√–‡ √‘∞ 𓬷æ∑¬å ‰™¬¬ß§å π«≈¬ß
ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬å≈”‰ â„À≠àœ ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬åÕÕ√å‚∏ªî¥‘° å ºŸâ·∑π°≈ÿà¡»—≈¬·æ∑¬åÀ≈Õ¥‡≈◊Õ¥
𓬷æ∑¬åπæ¥π—¬ ™—¬ ¡∫Ÿ√≥å 𓬷æ∑¬å∏π“ ∏ÿ√–‡®π 𓬷æ∑¬å∏”√ß‚√®πå ‡μÁ¡Õÿ¥¡
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6ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
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𓬷æ∑¬åπ‡√π∑√å ‚™μ‘√ π‘√¡‘μ 𓬷æ∑¬å ÿ¢‰™¬ “∑∂“æ√
∑’˪√÷°…“ºŸâÕ”π«¬°“√ ºŸâÕ”π«¬°“√
𓬷æ∑¬å∑Õߥ’ ™—¬æ“𑙠𓬷æ∑¬å«‘‡™“«å °Õ®√—≠®‘μμå
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7Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
°“√ª√–™ÿ¡«‘™“°“√ à«π¿Ÿ¡‘¿“§ ≥ ¡À“«‘∑¬“≈—¬ ߢ≈“π§√‘π∑√å
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8ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
æ√–¡À“°…—μ√‘¬å√Ÿªß“¡∑’Ë ÿ¥ ‡ªìππ—°‡√’¬ππհ查‰¥âÀ≈“¬¿“…“ ∑√߇ªìπ ÿ¿“æ∫ÿ√ÿ…∑√ß©≈Õßæ√–Õߧå(·μàß°“¬)¥’∑’Ë ÿ¥ °‘√‘¬“¡“√¬“∑¥’‡¬’ˬ¡∑√ß ÿ¿“æ ÿ¢ÿ¡ ÕàÕπ‚¬π ¡’æ√–Õ“√¡≥増π‚√·¡π쑧¡“° ∑√ß√—°‡¥’¬«„®‡¥’¬«∑√ß√—°°“√»÷°…“ ∑√ß√—°°“√Õà“πÀπ—ß ◊Õ∑√ß√—°¿“…“‰∑¬ ∑√ß√—° —μ«å∑√ß√—°™“μ‘∑’Ë ÿ¥ ∑√ß√—°ª√–™“™π∑’Ë ÿ¥¡’§«“¡∂àÕ¡μπ·≈–≈¥Õߧå≈ß¡“À“ª√–™“™π®πμ‘¥¥‘π∑’Ë ÿ¥¡’»√—∑∏“„πæ√–æÿ∑∏»“ π“∑’Ë ÿ¥ ∑√ß∫”‡æÁ≠∑“π¬‘Ëß°«à“ºŸâ „¥∑—Èß ‘Èπ‡ªìπºŸâ¡’»’≈¡—Ëπ§ß ∑√ß¡’ ¡“∏‘„π°“√∑”ß“πÕ¬à“߬‘Ëß∑√ß√Ÿâ∏√√¡≈÷° ÷́Èß∑’Ë ÿ¥ ¡’§«“¡‡¡μμ“∑’Ë ÿ¥¡’§«“¡°√ÿ≥“∑’Ë ÿ¥ ¡’§«“¡‡ ’¬ ≈–∑’Ë ÿ¥¡’§«“¡‡æ’¬√∑’Ë ÿ¥ ¡’§«“¡Õ¥∑π∑’Ë ÿ¥¡’§«“¡°μ—≠êŸ∑’Ë ÿ¥ ¡’æ√– 쑪í≠≠“≈÷° ÷́Èß∑’Ë ÿ¥¡’§«“¡√Ÿâ¡“°∑’Ë ÿ¥ ©≈“¥∑’Ë ÿ¥∑√߇ªìππ—°ª√“™≠å ∑√߇ªìπ§√Ÿ∑√߇ªìπ§’μ°«’ ∑√߇ªìππ—°¥πμ√’∑√߇ªìπ®‘μ√°√ ∑√߇ªìππ—°‡¢’¬π∑√߇ªìππ—°·ª≈ ∑√߇ªìππ—°ª√–¥‘…∞å∑√߇ªìππ—°æ—≤π“ ∑√߇ªìππ—° ”√«®∑√߇ªìππ—°‡¥‘π∑“ß ∑√߇ªìππ—°°’Ó‡°àß«‘∑¬“»“ μ√å ‡°àß«‘»«–‡°à߇∑§‚π‚≈¬’Ë ‡°àß ◊ËÕ “√‡°àßÕ—°…√»“ μ√å ‡°à߇»√…∞»“ μ√凰àß¿Ÿ¡‘»“ μ√å ‡°àß°ÆÀ¡“¬‡°àß°“√∑À“√ ‡°àß°“√‡°…μ√‡°à߇√◊ËÕߪɓ ‡°à߇√◊ËÕߥ‘π∑’Ë ÿ¥‡°à߇√◊ËÕßπÈ”∑’Ë ÿ¥ ‡°à߇√◊ËÕßΩπ∑’Ë ÿ¥‡°àß∂à“¬√Ÿª∑’Ë ÿ¥ ‡°àߥπμ√’∑’Ë ÿ¥
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9Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
Who is the most suitable position to take care
the surgical critically ill patients?
§«“¡‡®√ ‘≠° â“«Àπâ“∑“ߥ â“π°“√π”‡Õ“
‡∑§‚π‚≈¬’™—Èπ Ÿß·≈–π”Õ‘‡≈Á°∑√Õπ‘° å¡“„™â∑“ß
¥â“π°“√·æ∑¬å‰¥â°â“«ÀπⓉªÕ¬à“ß√«¥‡√Á«®π
°√–∑—Ëß°“√·æ∑¬å„πª√–‡∑»∑’Ë°”≈—ßæ—≤π“·≈–
¥âÕ¬æ—≤π“μ‘¥μ“¡§«“¡°â“«Àπâ“·∑∫‰¡à∑—π ∑”„Àâ
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√«¡∑—Èß«‘∏’°“√√—°…“°Á‡ª≈’ˬπ·ª≈߉ª®“°‡¥‘¡ ß“π
∑’Ë»—≈¬·æ∑¬å‡§¬∑”¡“°àÕπÀ≈“¬Õ¬à“߉¥â‡ª≈’ˬπ‰ª
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‡§√◊ËÕß¡◊Õ摇»…∑’Ë¡’≈—°…≥–§≈⓬ “¬≈«¥ (catheter)
Õ¥ºà“πÀ≈Õ¥‡≈◊Õ¥·¥ß®“°∫√‘‡«≥·¢πÀ√◊Õ¢“
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contrast media ºà“π‡¢â“∑“ß√Ÿ‡ªî¥¢ÕßÀ≈Õ¥‡≈◊Õ¥
∑’Ë¡“‡≈’ȬßÀ—«„®∑’ˇªìπ main coronary ∑—Èß 3 ‡ âπ
À“°æ∫«à“À≈Õ¥‡≈◊Õ¥·¥ß coronary ∑’Ë¡“‡≈’ȬßÀ—«
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À—«„®≈¥πâÕ¬≈ß ‡¡◊ËÕºŸâªÉ«¬ÕÕ°°”≈—ß°“¬‡æ’¬ß‡≈Á°
πâÕ¬°Á∑”„À⇰‘¥Õ“°“√‡®Á∫∫√‘‡«≥Àπâ“Õ°‰¥â ¡—¬
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À—«„®‰ª∑” coronary artery bypass graft ·μà‡¡◊ËÕ
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∑“ßÀ—«„® “¡“√∂„™â catheter Õ¥‡¢â“‰ª∑’ËÀ≈Õ¥
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°Á‰¥â„™â balloon ∑’Ëμ‘¥Õ¬Ÿàμ√ߪ≈“¬ catheter ¢¬“¬
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tery bypass graft °Á‰¥â ®–‡ÀÁπ‰¥â«à“Õ“¬ÿ√·æ∑¬å
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‰¥â√—∫§«“¡ –¥«°¢÷Èπ¡“° “¡“√∂™à«¬™’«‘μ§π‰¢â
‚√§À—«„®™π‘¥ acute ‰¥âÕ¬à“ß¡À—»®√√¬å∑’‡¥’¬«
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√–∫∫À√◊Õ organ ‡¡◊ËÕ‡°‘¥¡’欓∏‘ ¿“æ¢÷Èπ„π à«π
„¥¢Õß√à“ß°“¬¢ÕߺŸâªÉ«¬ ·æ∑¬å§π·√°∑’Ë¥Ÿ·≈ºŸâ
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‚¥¬‡©æ“–∑”„Àâ»—≈¬·æ∑¬å∑—Ë«‰ª´÷Ë߇§¬ºà“μ—¥‰¥â
‡°◊Õ∫∑ÿ°Õ«—¬«–¿“¬„π™àÕß∑âÕߢÕߺŸâªÉ«¬°≈—∫μâÕß
refer ºŸâªÉ«¬√“¬π—Èπ‰ªæ∫·æ∑¬å‡©æ“– à«πÀ√◊Õ
√–∫∫ μ—«Õ¬à“߇™àπ »—≈¬·æ∑¬å∑’Ë¥Ÿ·≈ºŸâªÉ«¬∑“ߥâ“π
upper gastrointestinal tract ®– refer À√◊Õ‰ªæ∫
·æ∑¬å„π à«π lower gastrointestinal tract À√◊Õ
à߉ªæ∫»—≈¬·æ∑¬å∑“ß hepato-biliary ®–‡ÀÁπ‰¥â
«à“ general surgeon §π‡¥’¬«°—ππ’È∑’ˇ§¬¥Ÿ·≈ºŸâªÉ«¬
√—°…“ºà“μ—¥ organ „π™àÕß∑âÕ߉¥â·∑∫∑ÿ° organ
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·æ∑¬å¬ÿ§„À¡à§‘¥®–∑”π—Èπ§ß‡≈àπ°—π πÿ°·πà„π∑’Ë ÿ¥
general surgeon ∑à“ππ’ȧ߮–‰¡à¡’§π‰¢â∑’ˇªìπ¢Õß
μ—«‡À≈◊ÕÕ¬Ÿà·¡â·μà§π‡¥’¬« ‡¡◊ËÕ‰¥â¡“π—Ëߧ‘¥πÕ𧑥
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·≈â«°Á√Ÿâ ÷°®–‡ªìπÀà«ß∑“ߥâ“π moral §àÕπ¢â“ß¡“°
®–∑”„Àâ general surgeons ·∫àß°≈ÿà¡°—πÕÕ°‰ª
∑”¡“À“°‘π°—π‡ªìπ°≈ÿà¡Ê ·∑π∑’ËÕ¬Ÿà°—π‡ªìπ°≈ÿà¡
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æ«°ÕÕ°‡ªìπ°≈ÿ࡬àÕ¬≈߉ªÕ’° „𧫓¡§‘¥‡ÀÁπ
à«πμ—«§‘¥«à“∑’ˇ√“‰¥â∑”°—π¡“°àÕπ∑’Ë»—≈¬·æ∑¬å‡√“
‰¥â·∫à߇ªìπ 9 “¢“π—Èπ¡—π¥’Õ¬Ÿà·≈â« μπ¬—ß√Ÿâ ÷°
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‰¥â·¬°μ—«ÕÕ°‰ªμ—È߇ªìπ√“™«‘∑¬“≈—¬μà“ßÀ“° μàÕ
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Õ◊Ëπ∑’Ë®–¡“ª√–°Õ∫‡¢â“¥â«¬°—π‡æ◊ËÕ‡ªìπ»—≈¬·æ∑¬å
∑’ËÕ¬Ÿà„πÕÿ¥¡°“√≥åÀ√◊Õ¿“…“Õ—ß°ƒ…‡√’¬°«à“ Model
surgeon º¡§‘¥«à“§ß‰¡à¡’ºŸâªÉ«¬§π„¥∑’ˉ¥â√—∫°“√
¥Ÿ·≈√—°…“®“°·æ∑¬å∑’Ë¡’§«“¡√Ÿâ·≈–§«“¡ “¡“√∂¥’
‡¬’ˬ¡·μ࢓¥¥â“π®√‘¬∏√√¡·≈–§ÿ≥∏√√¡¢Õߧ«“¡
‡ªìπ·æ∑¬å∑’Ë¥’ ¢ÕÕπÿ≠“μ°≈—∫¡“∑’Ë√–∫∫°“√¥Ÿ·≈
√—°…“„π¬ÿ§‰Œ‡∑§Õ’°§√—ÈßÀπ÷Ë߇√“¬—߇ªìπÀà«ß‡√◊ËÕß
general surgeon ¢Õ߇√“Õ¬Ÿ à ∂â“À“°‡√“‰¡à‰¥â
ª√—∫ª√ÿ߇√◊ËÕß curriculum ¢Õß°“√ training ¢Õß
surgical resident ¢Õ߉∑¬‡√“ º¡®–¢Õπ”‡Õ“
√–∫∫°“√ training ¢Õß residency training ∑“ß
»—≈¬»“ μ√å„π À√—∞Õ‡¡√‘°“¡“‡∑’¬∫°—∫¢Õ߉∑¬
®–æ∫«à“„™â‡«≈“Ωñ°Õ∫√¡π“π 5-6 ªï √«¡∑—Èߪï∑’ˇªìπ
surgical intern À√◊Õ∫“ߧπÕ“®„™â‡«≈“∂÷ß 7 ªï
‚¥¬∑’Ë√–À«à“ß training Õ¬Ÿàπ—Èπ¢Õ·¬°μ—«‰ª∑”«‘®—¬
‡ ’¬ 1 ªï¬‘Ëß∑”„À⧫“¡√Ÿâ∑’Ë®–°≈—∫¡“‡ªìπ§√Ÿ Õπ
π—°»÷°…“·æ∑¬å·≈– resident ‰¥â¥’¬‘Ëߢ÷Èπ ·æ∑¬å
∫“ß§π§‘¥Õ¬“°®–∑” Doctor of PhD §«∫§Ÿà‰ª
¥â«¬„π√–À«à“ß∑” residency training Õ¬Ÿà Õ“®„™â
‡«≈“‡æ‘Ë¡Õ’° 1 À√◊Õ 2 ªï∑’Ë ”§—≠·≈–®”‡ªìπμâÕß
„™â„π‡«™ªØ‘∫—μ‘ °“√‡√’¬π°“√ Õπ·≈–°“√∑”«‘®—¬
§”«à“ surgeon À√◊Õ general surgeon Õ¬à“ß∑’ˇ¡◊Õß
‰∑¬π‘¬¡„™â‡√’¬°°—πÕ¬Ÿà §«“¡√Ÿâ·≈–§«“¡ “¡“√∂¢Õß
surgeon ∑’˪√–‡∑» À√—∞Õ‡¡√‘°“μâÕß°“√π—Èπ‡ªìπ
§«“¡√Ÿâ∑“ߥâ“π»—≈¬»“ μ√å∑’˧àÕπ¢â“ß°«â“ß·≈–≈ß
≈÷°„π∫“ßÕ—πÀ√◊Õ„Àâ√ŸâÀ¡¥∑—Ë«∑—Èß√à“ß°“¬¥—ß®–‡ÀÁπ
‰¥â®“°√–À«à“ß∑’ˇ√“Õ¬Ÿà„π training „πªï·√°Ê
‡¢“®–®—¥„Àâ‡√“‰¥â rotate ºà“π∑ÿ° “¢“∑’ËÕ¬Ÿà„π¿“§
«‘™“»—≈¬»“ μ√å §◊Õ®–μâÕß¡’§«“¡√Ÿâ„π∑ÿ° “¢“
¬àÕ¬¢Õß»—≈¬»“ μ√å·≈–‡¡◊ËÕ¡’§«“¡®”‡ªìπ®√‘ßÊ
‡™àπ„π ∂“π°“√≥å∑’ËμâÕß°“√§«“¡√’∫¥à«π∑’ËÕ“®
‡ªìπÕ—πμ√“¬μàÕ™’«‘μ¢ÕߺŸâªÉ«¬·≈–‰¡à¡’ specialty
¡“Õ¬Ÿà„π∑’ˇ°‘¥‡Àμÿ‡¡◊ËÕ¡’§«“¡®”‡ªìπ general surgeon
∑’ËÕ¬Ÿà„π‡Àμÿ°“√≥å °ÁμâÕß¡’§«“¡ “¡“√∂æÕ∑’Ë®–
∑”°“√ºà“μ—¥™à«¬™’«‘μºŸâªÉ«¬π—Èπ‰¥â¥â«¬ ÷́Ëß°Á§≈⓬Ê
°—π¢Õß∑ÿ°ª√–‡∑»‡√‘Ë¡®“°‡®√‘≠πâÕ¬‰ªÀ“∑’ˇ®√‘≠
‡æ‘Ë¡¡“°¢÷Èπ À√—∞Õ‡¡√‘°“‡¢“¡’ª√–™“°√¡“°°«à“
ª√–‡∑»‡√“¡“°°«à“À≈“¬‡∑à“μ—«·≈–ºŸâ§π¢Õ߇¢“¡’
§ÿ≥¿“æ∑’Ë¥’·≈–‡Àπ◊Õ°«à“·≈–®”π«π°Á¡“°°«à“¥â«¬
®÷ß∑”„Àâ»—≈¬·æ∑¬å∑’˺≈‘μÕÕ°¡“·¬°°√–®“¬°—π
ÕÕ°¡“∑”·≈–Ωñ°„À⇪ìπ·æ∑¬åºŸâ™”π“≠°“√À√◊ÕºŸâ
‡™’ˬ«™“≠„π·μà≈–√–∫∫À√◊Õ à«π¢Õß√à“ß°“¬¥—ß∑’Ë
ª√“°ØÕ¬Ÿà®π∑ÿ°«—ππ’È®÷ß∑”„Àâ surgeon À√◊Õ general
surgeon ‰ª∑”ºà“μ—¥ à«π„À≠àÕ¬Ÿ à° —∫ organs
¿“¬„π™àÕß∑âÕ߇ªìπ à«π„À≠à ·μàæÕ¡“∂÷߬ÿ§¢Õß
‰Œ‡∑§°Á¬—ß¡’§π∫“ß§π§‘¥®–·∫àßμàÕ‰ª„Àâ‡À≈◊Õ
‡≈Á°·§∫≈߉ª°«à“π—ÈπÕ’°®π ÿ¥∑⓬ Õ“®®–‰¡à¡’
Õ–‰√‡À≈◊Õ°Á‰¥â
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11Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
„π∞“π–∑’ˇªìπ general surgeon §πÀπ÷Ëß
·≈–¡’ª√– ∫°“√≥å„π™à«ß∑’Ë∑” clinical practice
Õ¬Ÿà„π»‘√‘√“™´÷Ë߇ªìπ‚√߇√’¬π·æ∑¬å∑’˺≈‘μ·æ∑¬å
∑—Ë«‰ª·≈–·æ∑¬å‡©æ“–∑“ß∑’Ë„À≠à∑’Ë ÿ¥„πª√–‡∑»
„π™à«ß‡«≈“ 30-40 ªï∑’˺à“π¡“ ∂â“查∂÷ߺŸâªÉ«¬∑’˺¡
§≈ÿ°§≈’Õ¬Ÿàμ≈Õ¥‡«≈“ à«π„À≠à®–‡°’ˬ«¢âÕßÕ¬Ÿà°—∫
ºŸâªÉ«¬Àπ—°ª√–‡¿∑«‘°ƒμÀ√◊Õ∑’ˇ√’¬°«à“®”‡ªìπμâÕß
Õ“»—¬ acute surgical critical care ∑’ˇ°’ˬ«¢âÕßÕ¬Ÿà
°—∫ºŸâªÉ«¬Àπ—°∑’ËμâÕߥŸ·≈∑—π∑’·≈–μ‘¥μ“¡ºŸâªÉ«¬
Õ¬à“ß„°≈♑¥·≈–Õ¬à“ßμàÕ‡π◊ËÕß ºŸâªÉ«¬∑’˺¡‰¥â¥Ÿ·≈
·≈–¡’ª√– ∫°“√≥å¡“‡ªìπÕ¬à“ߥ’π—Ëπ§◊ÕºŸâªÉ«¬ severe
trauma, burns, shock ·≈– sepsis à«π¡“°®–
‡ªìπºŸâªÉ«¬∑’ˉ¥â√—∫ severe trauma ·≈– severe burn
∑’Ë àß¡“®“°‚√ß欓∫“≈Õ◊ËπÕ’°∑’Àπ÷Ëß Õ“®®–¡“
present °—∫‡√“¥â«¬‡√◊ËÕß shock ®“° hypovolemic
À√◊Õ septic shock μ—Èß·μà√–¬–·√°Ê °Á‰¥â∂â“°“√
„Àâ°“√¥Ÿ·≈√—°…“∑”‰¥â‰¡à∂Ÿ°μâÕß·≈–¥’æÕμ—Èß·μà
√–¬–·√°Ê °Á‰¥â„π∑”πÕ߇¥’¬«°—π°—∫‡√◊ËÕß sepsis
·≈– infection ¡—°®–‡°‘¥μ“¡¡“®“°º≈¢Õß°“√
¥Ÿ·≈¢Õß·æ∑¬å∑’Ë¢“¥ª√– ∫°“√≥å º¡‡§¬¥Ÿ·≈ºŸâ
ªÉ«¬∑’Ë¡’ acute severe hemorrhagic necrotizing
pancreatitis with multiple organs failure ¡“°°«à“
4 organ systems ¿“¬„π™àÕß∑âÕßæ∫¡’ severe sep-
tic abdomen ‡π◊ËÕß®“°¡’ near total gangrenous of
colon ®÷߉¥â∑” ileocolectomy æ√âÕ¡°—∫‡ªî¥·º≈
Àπâ“∑âÕß open ‰«âπ“πæÕ ¡§«√ ºŸâªÉ«¬√“¬π’ÈμâÕß„Àâ
prolonged respiratory support ·≈– nutritional
support ∑“ß TPN Õ¬Ÿàπ“π‡ªìπ‡¥◊Õπ „π™àÕß∑âÕß
°ÁμâÕ߇ՓºŸâªÉ«¬‰ª∑” re-exploration À≈“¬§√—Èß
‡æ√“–¡’‡√◊ËÕß intra peritoneal bleeding ®“° in-
flammation ∑’Ë¡’Õ¬Ÿà‡¥‘¡ºŸâªÉ«¬√“¬π’ÈμâÕßÕ“»—¬°“√
¥Ÿ·≈∑’ˇ ’¬ ≈–®√‘ßÊ ∑—È߇«≈“ °”≈—ß°“¬·≈–„®
‚¥¬∑—Ë«‰ª‚Õ°“ ∑’Ë®–√Õ¥™’«‘μ„πºŸâªÉ«¬∑’ËÕ¬Ÿà„π
¿“æÕ¬à“ßπ’ȇ°◊Õ∫®–‡ªìπ 0% ·μຟâªÉ«¬√“¬π’È√Õ¥
™’«‘μ¡“‰¥âÕ“®®–‡ªìπ‡æ√“–Õ“¬ÿ¬—߉¡à¡“°‡°‘π‰ª
(35 ªï) ·μà∑’Ë ”§—≠∑’Ë ÿ¥§◊ÕÕ¬Ÿà∑’Ëμ—«·æ∑¬å∑’Ë¥Ÿ·≈
√—°…“Õ¬à“ß„°≈♑¥„™â§«“¡Õ¥∑π·°âªí≠À“∑’ˇ°‘¥
¢÷Èπμ≈Õ¥‡«≈“∑’Ë¡’ªí≠À“‡°‘¥¢÷Èπ‚¥¬Õ“»—¬ªí≠≠“
®“°°“√‡√’¬π√Ÿâ·≈–À“ª√– ∫°“√≥å‡æ◊ËÕ„À≥⡓ ́ ÷Ëß
recognition ‡°’ˬ«°—∫ªí≠À“∑’ˇ°‘¥¢÷Èπ‡√’¬°«à“°“√∑”
decision making °“√¥Ÿ·≈√—°…“„πºŸâªÉ«¬∑—Èß Õß
°≈ÿà¡π’È®÷ßμâÕßÕ“»—¬ºŸâ‡™’ˬ«™“≠·≈–¡’ª√– ∫°“√≥å
¡“¥ŸºŸâªÉ«¬μ—Èß·μàμÕπ·√°∑’˺ŸâªÉ«¬‡√‘Ë¡‡¢â“¡“∑’Ë ER
·≈–¡’§«“¡®”‡ªìπμâÕß¡’§«“¡‡™’ˬ«™“≠„π°“√¥Ÿ·≈
™à«¬‡À≈◊Õ‡∫◊ÈÕßμâπμ“¡À≈—° Advanced Trauma Life
Support ´÷ Ëß general surgeon πà“®–¡’§«“¡
™”π“≠°«à“„π “¢“Õ◊ËπÊ „π case burn ∂◊Õ«à“‡ªìπ
à«πÀπ÷ËߢÕߺŸâªÉ«¬∫“¥‡®Á∫Õÿ∫—쑇Àμÿ πà“®–¡Õ∫
ß“π‡√‘Ë¡μ—Èß·μà°“√∑” resuscitation ‰ª®π°√–∑—Ëß
∂÷ß°“√∑”ºà“μ—¥ªî¥·º≈¥â«¬°“√∑” skin grafting
„Àâ°“√¥Ÿ·≈√–¬–‡√‘Ë¡μâπ¢ÕߺŸâªÉ«¬‡À≈à“π’È„π¡◊Õ¢Õß
general surgeon ´÷Ë߇ªìπ√–∫∫‡¥’¬«°—∫∑’Ë„™â„π
ª√–‡∑» À√—∞Õ‡¡√‘°“¢Õ„Àâ»—≈¬·æ∑¬åμ°·μàß·≈–
resident ∑“ß»—≈¬°√√¡μ°·μàß·≈– resident ∑“ß
»—≈¬°√√¡μ°·μàß confine ß“πÕ¬Ÿà„π à«π¢Õß re-
constructive burn surgery πà“®–‡À¡“– ¡°«à“
‡æ◊ËÕ∑”°“√»÷°…“§âπ§«â“„À≥⡓«à“®–À“«‘∏’∑’Ë®–π”
¡“„™â„π°“√ªÑÕß°—π·≈–√—°…“ scar ·≈– scar con-
tracture ∑’Ë¥’°«à“«‘∏’∑’Ë„™âÕ¬Ÿà„πªí®®ÿ∫—ππ’È ·∑∫∑ÿ°
ª√–‡∑»®–æ∫ºŸâªÉ«¬∑’Ë¡’ scar ·≈– scar contrac-
ture √Õ°“√™à«¬‡À≈◊Õ¥Ÿ·≈®“°∑à“πÕ¬Ÿà æ«°‡√“
∑√“∫¥’«à“»—≈¬·æ∑¬åμ°·μàßπâÕ¬§π∑’Ë π„®‡√◊ËÕß
Àß‘°Ê ßÕÊ ‡™àπ‡¥’¬«°—∫ general surgeon ∑’ˉ¡à
π„®¥Ÿ·≈ºŸâªÉ«¬ burn ·μàÕ’°‰¡à™â“‰¡àπ“πº¡‡°√ß
«à“ general surgeons ∑’ˉ¡à¡’§«“¡√Ÿâ·≈–‡™’ˬ«™“≠
∑“ߥâ“π„¥¥â“πÀπ÷Ë߇ªìπ摇»…‰ª®“°»—≈¬·æ∑¬å
∑—Ë«‰ª§πÕ◊Ëπ ®–À“ºŸâªÉ«¬¡“∑”ºà“μ—¥À√◊Õ¥Ÿ·≈‰¥â
¬“°¢÷Èπ ªí®®ÿ∫—π∑’ˇÀÁπ«à“¬—ßμâÕß„™â¡’¥ºà“μ—¥∑”Õ¬Ÿà
„π√Ÿª¢Õß emergency ·≈–À√◊Õ urgency ·≈–
μâÕßÕ“»—¬«‘∏’°“√μ√«®§âπ¥â«¬ high technology
´÷Ëß¡’§«“¡®”‡ªìπμâÕßÕ“»—¬‰Œ‡∑§¬—ß®”°—¥Õ¬Ÿà°—∫„π
case trauma ·≈– burn ‡∑à“π—Èπ general surgeon
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12ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
¬‘π¥’·≈–¿Ÿ¡‘„®∑’Ë®–¡“¥Ÿ·≈ à«πÕ◊Ëπ∑—ÈßÀ¡¥¬°‡«âπ
‡√◊ËÕß reconstructive surgery ¢Õß burn scar ·≈–
scar contracture Õ—μ√“°“√쓬¢ÕߺŸâªÉ«¬ burn ®“°
‚√ß欓∫“≈μà“ß®—ßÀ«—¥∑’Ë¡’°“√¥Ÿ·≈ ‚¥¬ general
surgeon ®–¡’Õ—μ√“쓬 Ÿß°«à“ ‚√ß欓∫“≈∑’Ë¡’
»—≈¬·æ∑¬åμ°·μàߥŸ·≈∑—Èßπ’È°Á‡æ√“– residents ∑“ß
general surgery ¡’§«“¡√Ÿâ®“°∑’Ë®—¥‰«â„πÀ≈—° Ÿμ√
¡’®”π«ππâÕ¬¡“° ¬‘ Ë߉ª°«à“π— Èπ®”π«π¢Õß
»—≈¬·æ∑¬å∑’Ë®∫°“√ training ∑“ß general surgery
¡’®”π«π¡“°°«à“°—πÀ≈“¬‡∑à“ ‡√◊ËÕßπ’ÈμâÕ߇√’¬π„Àâ
°√√¡°“√∑’Ë¥Ÿ·≈ residency training ∑“ß»—≈¬°√√¡
¿“¬„μâ°“√¥Ÿ·≈¢Õß√“™«‘∑¬“≈—¬»—≈¬·æ∑¬åœ ‰¥â√—∫
∑√“∫‡æ√“–‡ªìπ‡√◊ËÕß∑’Ëπà“ π„®∑’Ë »—≈¬·æ∑¬å∑—Ë«‰ª®–
‰¥â𔧫“¡√Ÿâ·≈–ª√– ∫°“√≥剪ª√–¬ÿ°μ儙Ⱇ∫
ºŸ âªÉ«¬‚√§Õ◊ËπÊ ‰¥â¥â«¬ª√–‚¬™πåμàÕμ—«‡√“‡Õß
Õ¬à“ßπâÕ¬‡¡◊ËÕ∑à“π¡’§«“¡√Ÿâ‡√◊ËÕß burn ¥’¢÷Èπ∑à“π®–
‰¥â‡¢â“„®‡√◊ËÕß metabolic changes ·≈– nutritional
support „πºŸâªÉ«¬«‘°ƒμ‰¥â¥’¢÷Èπ¡“√«¡∑—È߇√◊ËÕß im-
munity „πºŸâªÉ«¬ burn ¥â«¬ ´÷Ë߇ªìπ‡Àμÿº≈∑’Ë«à“
∑”‰¡®÷ß®”‡ªìπμâÕß·¬°¥Ÿ·≈ºŸâªÉ«¬μ—Èß·μà√—∫‡¢â“¡“
„À¡àÊ „π À√—∞Õ‡¡√‘°“∑’ˇªìπ medical center „À≠àÊ
‡¢“®–‡μ√’¬¡ √â“ß burn unit ‰«â°àÕπ‡ ¡Õ ¡ÿ¡¡Õß
¢ÕߧπÕ‡¡√‘°—π·≈–ª√–‡∑»∑“ßμ–«—πμ°®–¡’¡ÿ¡
¡Õßμ√ߢⓡ°—∫ª√–‡∑»∑“ßμ–«—πÕÕ° º¡¢Õ√—∫
√Õß«à“∂â“ residents »—≈¬»“ μ√å¢Õ߇√“‰¥â‡¢â“„®
°“√‡ª≈’ˬπ·ª≈ß∑’ˇ°‘¥¢÷Èπ„π‡√◊ËÕß∑’ˇ°’ˬ«°—∫ patho-
physiologic changes „π∑ÿ°Ê ¢—ÈπμÕπ¢Õß°“√
‡ª≈’ˬπ·ª≈ß„πμ—«§π‰¢â burn ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫
°—∫°“√¥Ÿ·≈ºŸâªÉ«¬∑“ß»—≈¬°√√¡Õ◊ËπÊ ·≈â«®–∑”„Àâ
¡’§«“¡√Ÿâ ÷°«à“°“√¥Ÿ·≈ºŸâªÉ«¬Õ◊ËπÊ ‡ªìπ¢Õß∏√√¡¥“
‰ªÀ¡¥ º¡®”‰¥â«à“μÕπ∑’˺¡ Õ∫∫Õ√å¥ Surgery
part 2 (Oral) „π™à«ß‡«≈“∑’˺¡‡ªìπ Fellow ∑”ß“π
Õ¬Ÿà°—∫ Top burn surgeon ¢Õß À√—∞Õ‡¡√‘°“º¡
“¡“√∂μÕ∫§”∂“¡∑’Ë Professor ‡¢“∂“¡º¡¡“
‰¥â∑ÿ°¢âÕ§”∂“¡ º¡§‘¥«à“§”μÕ∫∑’ËμÕ∫‡¢“‰ªπ—Èπ
μ√ß°—∫‡ªÑ“∑’ˇ¢“∂“¡¡“∑”„ÀâÕ“®“√¬åºŸâ Õ∫∂“¡º¡
‰¥â‰¡à°’˧”∂“¡°ÁÀ¬ÿ¥∂“¡ À—π‰ª§ÿ¬‡√◊ËÕßÕ◊Ëπ·∑π
¢Õ®∫‡æ’¬ß‡∑à“π’È º¡¢ÕΩ“°º≈ß“π°“√¥Ÿ·≈ºŸâªÉ«¬
very severe critical patients ∑’ˇ¢â“¡“§√—Èß·√° pre-
dict prognosis ‰«â«à“ºŸâªÉ«¬Àπ—°‡À≈à“π’ȉ¡àπà“®–¡’
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13Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
‰∑¬¡’æ◊Èπ∑’Ë 513,120 μ“√“ß°‘‚≈‡¡μ√ („À≠à‡ªìπ
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14ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
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4. Applied Thailand 4.0 ‡ªìπÀ≈—°°“√∑’Ë®–
𔉪„™âæ—≤𓉥â∑ÿ°Ê “¢“«‘™“™’æ (Professional-
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( ‘ߧ‚ª√å„™â√âÕ¬≈– 2.905 ¢Õß GDP ¡’§√ŸμàÕ
π—°‡√’¬π 1 : 23 Õ¬Ÿà≈”¥—∫∑’Ë 57 - ¢Õ߇°“À≈’„™â
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15Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
»÷°…“¢Õ߇√“‰¡à‰¥âÕ¬Ÿà∑’Ëß∫ª√–¡“≥À√◊ÕÕ—μ√“ à«π
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çSmart learningé „π¬ÿ§∑’Ë¡’π«—μ°√√¡μà“ßÊ ‡°‘¥¢÷Èπ
¡“°¡“¬‡æ◊ËÕ‡¢â“ Ÿà çThailand 4.0é °“√‡√’¬π -
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¡’§«“¡·μ°μà“ߢÕߺŸ â Õπ·≈–ºŸâ‡√’¬πÕ¬à“ß¡“°
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17Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
Õ¬“°‡ÀÁπ RCST Membership Profile
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19Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
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21Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
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identification, reimbursement, informed consent,
site marking, medical reconciliation, clinical path-
way, WHO surgical safety checklist, operative
note, recovery room monitoring, progress note,
discharge planning ‡ªìπμâπ √–∫∫‡À≈à“π’È ∑à“π
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22ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
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2. Competency in up to date knowledge,
skill and decision making
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4. Responsibility
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5. Honesty and Integrity
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6. Role model and mentor
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7. Patientsû right, dignity and involvement
in decision making
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√à«¡„π°“√μ—¥ ‘π„®·ºπ°“√√—°…“
8. No conflict of interest and Equity
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9. Confidentiality
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10. Good communication
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23Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
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24ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
‡¡◊ËÕ«—π∑’Ë 17 °—𬓬π 2560 ´÷Ë߇ªìπ«—π Global Day of Patient Safety ¢Õß WHO ·≈– Thailand
Patient and Personnel Safety Day ≥ Õ‘¡·æ§ ‡¡◊Õß∑Õß∏“π’ »“ μ√“®“√¬å§≈‘π‘° ‡°’¬√쑧ÿ≥ 𓬷æ∑¬å
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¬ÿ∑∏»“ μ√姫“¡ª≈Õ¥¿—¬¢ÕߺŸâªÉ«¬·≈–∫ÿ§§≈“°√ “∏“√≥ ÿ¢¢Õߪ√–‡∑» (Strategic Direction for 2P Safety
of Thailand) „Àâ°—∫ºŸâ‡¢â“ª√–™ÿ¡ ª√–°Õ∫¥â«¬ºŸâ·∑π®“°Õߧå°√«‘™“™’æ 15 Õߧå°√ √«¡∑—Èß√“™«‘∑¬“≈—¬
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·π«§‘¥¢Õ߬ÿ∑∏»“ μ√å°“√¢—∫‡§≈◊ËÕππ‚¬∫“¬ 2P Safety ¥—ß√Ÿª
2P Safety “Patient Safety Goals:SIMPLE Thailand 2017”𓬷æ∑¬åæ√‡∑æ ‡ª√¡‚¬∏‘π
¥Ÿ‡æ‘Ë¡‡μ‘¡‰¥â∑’Ë https://www.youtube.com/watch?v=Ka1b0GzaNYM
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√–∫∫∫√‘°“√ ÿ¢¿“æ ‚¥¬ ∂“∫—π√—∫√Õߧÿ≥¿“æ ∂“π欓∫“≈( √æ.) √à«¡°—∫ª≈—¥°√–∑√«ß “∏“√≥ ÿ¢
·≈–§≥–‰¥âμ—Èߧ≥–Õπÿ°√√¡°“√ºŸâ‡™’ˬ«™“≠ ‚¥¬°“√°”Àπ¥‡ªÑ“À¡“¬§«“¡ª≈Õ¥¿—¬μ“¡·π«ªØ‘∫—μ‘∑’ˇ√’¬°
‚¥¬¬àÕ«à“ SIMPLE ∑—Èß ”À√—∫ºŸâªÉ«¬·≈–∫ÿ§§≈“°√ ®—¥∑”‡ªìπ E Book ‚¥¬¡’‚§√ß √â“ß·μà≈–¢âÕª√–°Õ∫¥â«¬
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25Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
§”®”°—¥§«“¡ Definition
‡ªÑ“À¡“¬ Goal
‡Àμÿº≈∑’ËμâÕß∑” Why
°√–∫«π°“√ Process
°“√„À⧫“¡√Ÿâ Ωñ°Õ∫√¡ Training
°“√‡ΩÑ“μ‘¥μ“¡ Monitoring
¢âÕ®”°—¥ Pitfall
·À≈à߇հ “√Õâ“ßÕ‘ß Reference
‡æ◊ËÕ„À⺟âªØ‘∫—μ‘ß“π𔉪ª√–¬ÿ°μ儙≥⠖¥«°‡À¡“– ¡°—∫·μà≈–∫√‘∫∑¢ÕßÀπà«¬ß“π ¥—ßμ—«Õ¬à“ßμàÕ
‰ªπ’È
S 1.4: Venous Thromboembolism (VTE) Prophylaxis
Definition ¿“«–°“√‡°‘¥≈‘Ë¡‡≈◊Õ¥„πÀ≈Õ¥‡≈◊Õ¥¥”∑’ËÕ¬Ÿà à«π≈÷°¢Õߢ“ (Deep vein thrombosis) ∂â“
Õ¬Ÿà∫√‘‡«≥‡Àπ◊Õ¢âÕ‡¢à“¢÷Èπ‰ª (Proximal DVT) ¡’‚Õ°“ ∑’Ë®–‡°‘¥¿“«–Õÿ¥°—Èπ„πªÕ¥ (Pul-
monary embolism) „π√–¬–‡©’¬∫æ≈—π ¡’√–¥—∫§«“¡√ÿπ·√ßμ—Èß·μàπâÕ¬‰ªÀ“¡“°
∑”„À⇰‘¥æ¬“∏‘ ¿“æ∑’Ë·μ°μà“ß°—π Õ“®®–∑”„À⺟âªÉ«¬‡ ’¬™’«‘μ∂÷ß·¡â®–‰¥â√—∫°“√√—°…“
Goal ªÑÕß°—π°“√‡°‘¥≈‘Ë¡‡≈◊Õ¥„πÀ≈Õ¥‡≈◊Õ¥¥”¢Õߢ“ (Deep Vein Thrombosis) ·≈–¿“«–
≈‘Ë¡‡≈◊Õ¥Õÿ¥°—Èπ„πªÕ¥ (Pulmonary Embolism; PE) „πºŸâªÉ«¬»—≈¬°√√¡
Why °“√‡°‘¥≈‘Ë¡‡≈◊Õ¥„πÀ≈Õ¥‡≈◊Õ¥¥”¢Õߢ“·≈–¡’¿“«–≈‘Ë¡‡≈◊Õ¥Õÿ¥°—Èπ„πªÕ¥ ‡ªìπ¿“«–
·∑√°´âÕπ∑’Ë©—∫æ≈—π·≈–√ÿπ·√ß ∑”„À⺟âªÉ«¬¡’Õ—μ√“쓬 Ÿß ∂÷ß·¡â®–«‘π‘®©—¬·≈–√—°…“
∑—π∑à«ß∑’ ´÷Ëß°“√μ√–Àπ—°∂÷ߪí≠À“π’È ·≈–°“√ª√–‡¡‘πªí®®—¬‡ ’ˬßÕ¬à“߇ªìπ√–∫∫·≈–
‡À¡“– ¡ ‡æ◊ËÕªÑÕß°—π‡¡◊ËÕæ∫«à“¡’§«“¡‡ ’ˬ߄π√–¥—∫∑’Ë¡’π—¬ ”§—≠ §«√π”¡“μ√°“√
ªÑÕß°—π¡“„™â
Process °“√ª√–‡¡‘π
„πºŸâªÉ«¬»—≈¬°√√¡∑—Èß¿“«–ª°μ‘·≈–©ÿ°‡©‘π ∑’Ë√—∫‰«â„π‚√ß欓∫“≈ μâÕߪ√–‡¡‘π‚Õ°“ ‡°‘¥
VTE μ“¡ªí®®—¬‡ ’Ë¬ß ‡™àπ
1. ¢âÕ¡Ÿ≈¢ÕߺŸâªÉ«¬ ‡™àπ Õ“¬ÿ ‡æ» œ≈œ (Demographic Data)
2. ª√–«—μ‘À√◊Õª√–«—쑧√Õ∫§√—« ‡§¬‡ªìπ VTE ¡“°àÕπ
3. ¡’ª√–«—쑇§¬‡ªìπ¡–‡√Áß∑’Ë„¥∑’ËÀπ÷ËßÀ√◊Õ°”≈—߇ªìπÕ¬Ÿà
4. ‰¥â√—∫ŒÕ√å‚¡πÕ¬à“ßμàÕ‡π◊ËÕß
5. ¡’°“√∫“¥‡®Á∫¢ÕßÀ≈Õ¥‡≈◊Õ¥ (Major vascular injuries) ‡™àπ Pelvic fracture
6. πÕππ“π‡°‘π 4 «—πÀ≈—ߺà“μ—¥ (Delayed ambulation)
œ≈œ
À√◊Õ Õ“®®–„™â Caprini Risk Assessment Model for VTE ‡¡◊ËÕæ∫«à“ºŸâªÉ«¬¡’§«“¡
‡ ’ˬߢÕß VTE „π√–¥—∫∑’Ë¡’π—¬ ”§—≠ ‡ªìπμâπ
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26ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
°“√ªÑÕß°—π
§«√π”¡“μ√°“√°“√ªÑÕß°—π ¥—ßπ’È
1. „À⧔·π–π”°—∫ºŸâªÉ«¬„ÀâÕÕ°°”≈—ߢâÕ‡∑â“ (Foot ankle exercise, ankle pump)
2. Early ambulation
3. Mechanical prophylaxis ‰¥â·°à «¡∂ÿß Graduated Compression Stockings (GCS)
À√◊Õ «¡ Intermittent pneumatic compression devices (IPCD) ∂â“¡’Õÿª°√≥åπ’È
‡¡◊ËÕ‰¡à¡’¢âÕÀâ“¡ ‡™àπ Severe peripheral arterial disease, Congestive heart failure
(CHF), Acute superficial venous thrombosis
4. Pharmacological prophylaxis ®”‡ªìπμâÕߪ√–‡¡‘π¿“«–‡≈◊Õ¥ÕÕ°º‘¥ª°μ‘°àÕπ‡ ¡Õ
°“√„À⬓ ‡™àπ Aspirin À√◊Õ¬“Õ◊Ëπ Ê μ“¡À≈—°∞“π∑“ß«‘™“°“√ À√◊Õμ“¡§”
·π–π”¢ÕßÕߧå°√«‘™“™’æ
À≈—ߺà“μ—¥¡’°“√ª√–‡¡‘π‡ΩÑ“√–«—ßÕ“°“√¢Õß DVT ‡™à𠪫¥ ∫«¡ ¢Õߢ“ μ√«®√à“ß°“¬
·≈–μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√ ‡æ◊ËÕÀ“ “‡Àμÿ ∂Ⓡ°‘¥®“° DVT ¢ÕßÀ≈Õ¥‡≈◊Õ¥¥”‡Àπ◊Õ
À—«‡¢à“ μâÕß√’∫„Àâ°“√¥Ÿ·≈√—°…“Õ¬à“߇À¡“– ¡ ‡æ◊ËÕ≈¥°“√‡°‘¥ PE
Training „À⧫“¡√Ÿâ·≈–∑∫∑«π¿“«– VTE ·°àºŸâ√à«¡ß“π‡ªìπ√–¬– Ê √≥√ߧå„Àâ¡’°“√Õ¿‘ª√“¬
®“°°√≥’»÷°…“ ‡√’¬π√Ÿâ®“°°‘®°√√¡∑∫∑«π
Monitoring §«√¡’°“√μ‘¥μ“¡°√–∫«π°“√¥—ßμàÕ‰ªπ’È
1. °“√ª√–‡¡‘π‚Õ°“ ‡ ’ˬß∑’Ë®–‡°‘¥¿“«–π’È„πºŸâªÉ«¬
2. °“√ —́°ª√–«—μ‘ªí®®—¬‡ ’ˬß∑’Ë ”§—≠
3. °“√π”¡“μ√°“√ªÑÕß°—π∑’ˇÀ¡“– ¡¡“„™â
4. ‡°Á∫¢âÕ¡Ÿ≈ºŸâªÉ«¬À≈—ߺà“μ—¥∑’Ë¡’¢“∫«¡ ·≈–„Àâ°“√«‘π‘®©—¬«à“‡ªìπ Proximal DVT ( Ÿß
°«à“À—«‡¢à“)
5. ‡°Á∫¢âÕ¡Ÿ≈ºŸâªÉ«¬À≈—ߺà“μ—¥∑’ˉ¥â√—∫°“√«‘π‘®©—¬«à“‡ªìπ PE ‚¥¬°“√∑” Computed
Tomography Angiography (CTA) ‡æ◊ËÕÀ“ªí®®—¬¢Õß°“√‡°‘¥
§«√√“¬ß“πÕÿ∫—μ‘°“√≥凰‘¥¿“«– Venous Thromboembolism (VTE) À≈—ߺà“μ—¥
Pitfall - °“√¢“¥§«“¡μ√–Àπ—°¢ÕߺŸâªØ‘∫—μ‘ß“π„π‡√◊ËÕßπ’È ∂÷ß·¡â®–¡’¢âÕ¡Ÿ≈‡™‘ߪ√–®—°…å
- ª√–‡∑»‰∑¬§«√¡’¢âÕ¡Ÿ≈ VTE „π√–¥—∫™“쑇æ◊ËÕ„™â„π°“√‡ª√’¬∫‡∑’¬∫·≈–»÷°…“·π«∑“ß
¥”‡π‘π°“√
Reference 1. Sachdeva A, Dalton M, Amaragiri SV, Lees T. Graduated compression stockings
for prevention of deep vein thrombosis. Cochrane Database Syst Rev. 2014 Dec
7;(12): CD001484.
2. Pootracool P. VTE Prophylaxis in Surgical Practice. Division of Vascular and
Transplantation, Dept. of Surgery, Ramathibodi Hospital, Faculty of Medicine,
Mahidol University.
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27Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
SIMPLE μ“¡À—«¢âÕ¥—ßμàÕ‰ªπ’È
Thailand Patient Safety Goals
Thailand Personnel Safety Goals
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28ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
S: Safe Surgery
S: Safe Surgery
S 1 Safe Surgery and Invasive Procedure
S 1.1 Surgical Safety Checklist
S 1.2 Surgical Site Infection Prevention
S 1.3 Enhanced Recovery After Surgery
S 1.4 Venous Thromboembolism Prophylaxis
S 2 Safe Anesthesia
S 3 Safe Operating Room
S 3.1 Safe Environment
S 3.2 Safe Surgical Instrument and Device
S 3.3 Safe Surgical Care Process
¡’°“√‡æ‘Ë¡®“° SIMPLE (2008) ‰¥â·°à
S 1.3 Enhanced Recovery After Surgery (ERAS)
S 1.4 Venous Thromboembolism Prophylaxis (VTE prophylaxis)
·≈– S 3 Safe Operating Room ‰¥â·°à
S 3.1 Safe Environment
S 3.2 Safe Surgical Instrument and Device
S 3.3 Safe Surgical Care Process
»—≈¬·æ∑¬å·≈–∑’¡ß“π‡ªìπºŸâ¢—∫‡§≈◊ËÕπ∑’Ë ”§—≠∑’Ë ÿ¥∑’Ë®–∑”„Àâ∫√√≈ÿ‡ªÑ“À¡“¬¥—ß°≈à“«¢â“ßμâπ„À≥âÕ¬à“ß
‡ªìπ√Ÿª∏√√¡ ‚¥¬¬÷¥‡Õ“ºŸâªÉ«¬‡ªì𠔧—≠ √â“ß·≈–æ—≤π“√–∫∫°≈‰°∑’Ë®”‡ªìπ‡æ◊ËÕ¡‘„Àâ‡ÀμÿÕ—π‰¡àæ÷ß
ª√– ߧå∑’˪ÑÕß°—π‰¥â ‡°‘¥¢÷ÈπÀ√◊Õ≈¥≈ß„π√–¥—∫∑’ˬա√—∫‰¥â μ≈Õ¥°√–∫«π°“√∑”ß“π ¥â«¬§«“¡√à«¡¡◊Õ
√à«¡„®·≈– √â“ߧ«“¡‡¢â“„®´÷Ëß°—π·≈–°—π√–À«à“ß∑’¡ß“π ºŸâªÉ«¬·≈–≠“쑇æ◊ËÕº≈°“√√—°…“∑’Ë¥’¡’§ÿ≥¿“æ„π
∑ÿ°¡‘쑇ªìπ∑’Ëπà“‰«â«“ß„®¢Õß∑ÿ°§π∑’ˇ°’ˬ«¢âÕß ¥â«¬§«“¡‚ª√àß„ „À⠗ߧ¡μ√«® Õ∫»—≈¬ªØ‘∫—μ‘∑’Ë¥’‰¥â
√“¬≈–‡Õ’¬¥¢Õß Patient Safety Goals : SIMPLE Thailand 2017 ‡¡◊ËÕ‡ √Á® ¡∫Ÿ√≥å·≈â«®–π”¢÷Èπ
Website ¢Õß√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬μàÕ‰ª
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29Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
¢âÕ¡Ÿ≈ ¡“™‘°√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬≥ «—π∑’Ë 8 惻®‘°“¬π æ.». 2560
8/11/2560 ®”π«π∑—Èß ‘Èπ ¡“™‘°¡’™’«‘μ
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»—≈¬»“ μ√嬟‚√«‘∑¬“ 196 181
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°ÿ¡“√»—≈¬»“ μ√å 142 137
»—≈¬»“ μ√å≈”‰ â„À≠à·≈–∑«“√Àπ—° 33 30
Maxillofacial ( ¡“™‘°«‘ “¡—≠) 2 2
√«¡ 3,324 3,196
¡“™‘° ¡“™‘° ¡“™‘° ¡“™‘° ¡“™‘° ¡“™‘°
8/11/2560 “¡—≠ «‘ “¡—≠ “¡—≠ “¡—≠ «‘ “¡—≠ «‘ “¡—≠
∑—Èß ‘Èπ ∑—Èß ‘Èπ ¡’™’«‘μ ‡ ’¬™’«‘μ ¡’™’«‘μ ‡ ’¬™’«‘μ
»—≈¬»“ μ√å∑—Ë«‰ª 2151 7 2100 51 6 1
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°ÿ¡“√»—≈¬»“ μ√å 142 0 137 5 0 0
»—≈¬»“ μ√å≈”‰ â„À≠à·≈–∑«“√Àπ—° 33 0 30 3 0 0
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30ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
«—𠔧—≠‡¥◊Õπ°—𬓬π 2560 - °ÿ¡¿“æ—π∏å 2561
°—𬓬π 2560
● 1 °—𬓬π 2560 «—π ◊∫ 𓧖‡ ∂’¬√
● 3 °—𬓬π 2560 «—π‡°‘¥‚¥√“‡Õ¡Õπ
● 5 °—𬓬π 2560 «—π “√∑®’π
● 15 °—𬓬π 2560 «—π»‘≈ªá æ’√–»√’
● 16 °—𬓬π 2560 «—π‚Õ‚´π‚≈°
● 17 °—𬓬π 2560 «—π·Ààߧ«“¡ª≈Õ¥¿—¬¢ÕߺŸâªÉ«¬‚≈° (Global Day of Patient Safety)/«—π·Ààß
§«“¡ª≈Õ¥¿—¬¢ÕߺŸâªÉ«¬·≈–∫ÿ§≈“°√ “∏“√≥ ÿ¢¢Õߪ√–‡∑»‰∑¬ (Thailand
Patient and Personnel Safety Day)
● 19 °—𬓬π 2560 «—πæ‘æ‘∏¿—≥±å‰∑¬
● 20 °—𬓬π 2560 «—π‡¬“«™π·Ààß™“μ‘ / «—πÕπÿ√—°…å√—°…“§Ÿ§≈Õß·Ààß™“μ‘ /«—π “√∑‰∑¬
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● 22 °—𬓬π 2560 «—π·√¥‚≈° / «—π§“√åø√’‡¥¬å (Car Free Day)
● 24 °—𬓬π 2560 «—π¡À‘¥≈
● 27 °—𬓬π 2560 «—π‡°‘¥ Google
● 28 °—𬓬π 2560 «—πæ√–√“™∑“π∏ß™“쑉∑¬ / «—πªÑÕß°—π‚√§æ‘… ÿπ—¢∫â“‚≈°
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/ «—π√—°μâπ‰¡âª√–®”ªï¢Õß™“μ‘ /«—π§≈⓬«—πæ√–√“™ ¡¿æ¢Õß ¡‡¥Á®¬à“ /
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31Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
● 22 μÿ≈“§¡ 2560 ‡∑»°“≈°‘π‡®
● 23 μÿ≈“§¡ 2560 «—πªî¬¡À“√“™ / ‡∑»°“≈°‘π‡®
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„πÀ≈«ß √—™°“≈∑’Ë 9 ≥ «—¥√“™∫æ‘∏ ∂‘μ¡À“ ’¡“√“¡√“™«√«‘À“√ ·≈–«—¥∫«√
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● 31 μÿ≈“§¡ 2560 «—πŒ“‚≈«’π / «—πÕÕ¡·Ààß™“μ‘
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● 6 惻®‘°“¬π 2560 «—π§≈⓬«—π‡°‘¥ »“ μ√“®“√¬å πæ.Õÿ¥¡ ‚ª…–°ƒ…≥–
● 11 惻®‘°“¬π 2560 «—π§πæ‘°“√·Ààß™“μ‘ (‡ “√å∑’Ë 2 ¢Õ߇¥◊Õπ惻®‘°“¬π)
● 14 惻®‘°“¬π 2560 «—πæ√–∫‘¥“·ÀàßΩπÀ≈«ß
● 20 惻®‘°“¬π 2560 «—π°Õß∑—æ‡√◊Õ
● 25 惻®‘°“¬π 2560 «—π«™‘√“«ÿ∏ / «—πª√–∂¡»÷°…“·Ààß™“μ‘
● 27 惻®‘°“¬π 2560 «—π “∏“√≥ ÿ¢·Ààß™“μ‘
∏—𫓧¡ 2560
● 1 ∏—𫓧¡ 2560 «—π‡Õ¥ å‚≈° / «—π¥”√ß√“™“πÿ¿“æ
● 3 ∏—𫓧¡ 2560 «—π§πæ‘°“√ “°≈
● 4 ∏—𫓧¡ 2560 «—π ‘Ëß·«¥≈âÕ¡‰∑¬
● 5 ∏—𫓧¡ 2560 «—πæàÕ·Ààß™“μ‘ / «—π™“μ‘ / «—π¥‘π‚≈° /«—π§≈⓬«—πæ√–∫√¡√“™ ¡¿æ æ√–∫“∑
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● 15 ∏—𫓧¡ 2560 «—π™“ “°≈
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32ªï∑’Ë 42 ©∫—∫∑’Ë 3 °—𬓬π-∏—𫓧¡ 2560®ÿ≈ “√√“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬
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● 25 ∏—𫓧¡ 2560 «—π§√‘ μå¡“ / «—π§√∫√Õ∫°“√°àÕμ—Èß ¡“§¡·æ∑¬å‚√§À—«„®·Ààߪ√–‡∑»‰∑¬ „π
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● 28 ∏—𫓧¡ 2560 «—π ¡‡¥Á®æ√–‡®â“μ“° ‘π¡À“√“™
● 31 ∏—𫓧¡ 2560 «—π ‘Èπªï
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● 2 ¡°√“§¡ 2561 «—πÀ¬ÿ¥™¥‡™¬«—π ‘Èπªï
● 8 ¡°√“§¡ 2561 «—π§≈⓬«—πª√– Ÿμ‘ æ√–‡®â“À≈“π‡∏Õ æ√–Õߧ凮ⓠ‘√‘«—≥≥«√’π“√’√—μπå
● 13 ¡°√“§¡ 2561 «—π‡¥Á° / «—π°“√∫‘π·Ààß™“μ‘
● 14 ¡°√“§¡ 2561 «—πÕπÿ√—°…å∑√—欓°√ªÉ“‰¡â¢Õß™“μ‘
● 16 ¡°√“§¡ 2561 «—π§√Ÿ
● 17 ¡°√“§¡ 2561 «—π‚§π¡·Ààß™“μ‘ / «—πæàÕ¢ÿπ√“¡§”·Àß¡À“√“™
● 18 ¡°√“§¡ 2561 «—π ¡‡¥Á®æ√–π‡√»«√¡À“√“™ / «—π°Õß∑—æ‰∑¬
● 29 ¡°√“§¡ 2561 «—π§√∫√Õ∫«—π‡ ’¬™’«‘μæ—π‚∑ („π°Õß∑—æ∫°Õ—ß°ƒ…) ∫ÿ≠ºàÕß ‘√‘‡«™™–æ—π∏å
°ÿ¡¿“æ—π∏å February 2561
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● 4 °ÿ¡¿“æ—π∏å 2561 «—π¡–‡√Áß‚≈°
● 10 °ÿ¡¿“æ—π∏å 2561 «—πÕ“ “√—°…“¥‘π·¥π
● 13 °ÿ¡¿“æ—π∏å 2561 «—π√—°π°‡ß◊Õ°
● 14 °ÿ¡¿“æ—π∏å 2561 «—𫓇≈π‰∑πå
● 16 °ÿ¡¿“æ—π∏å 2561 «—πμ√ÿ…®’π
● 18 °ÿ¡¿“æ—π∏å 2561 «—π¬ÿ∑∏À—μ∂’
● 22 °ÿ¡¿“æ—π∏å 2561 «—π§√∫√Õ∫°“√°àÕμ—Èß ¡“§¡»—≈¬·æ∑¬åμ°·μàß·Ààߪ√–‡∑»‰∑¬
● 24 °ÿ¡¿“æ—π∏å 2561 «—π»‘≈ªîπ·Ààß™“μ‘
● 25 °ÿ¡¿“æ—π∏å 2561 «—π«‘∑¬ÿ°√–®“¬‡ ’¬ß·Ààß™“μ‘
● 26 °ÿ¡¿“æ—π∏å 2561 «—π À°√≥å·Ààß™“μ‘
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33Bulletin Royal College of Surgeons of Thailand Volume 42 Issue 3 September-December 2017
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‡≈¢ª√–°Õ∫«‘™“™’懫™°√√¡ ........................................................................................
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®“° ∂“∫—π .....................................................................................................................
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®“° ∂“∫—π .....................................................................................................................
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®“° ∂“∫—π ............................................................................................
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