中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/41277

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(1)ύ୯ᙴᛰεᏢύ୯ᙴᏢࣴ‫܌ز‬ᅺγፕЎ ጓဦǺGICMS-375. ࡰ Ꮴ ௲ ௤Ǻ݅ࡿ۪. ௲௤. ፕЎᚒҞ ε໳Ғ૛෯‫ׯ‬๓Ӽჱੰ‫ੰ܊‬஻ ߡઝੱ‫ރ‬ϐӃ០ࣴ‫ز‬ DaHuang GangTsao Tang to improve the constipation syndrome of cancer patients in late-stage: A pilot study. ࣴ‫ز‬ғǺቅ‫ػ‬ቺ. ύ๮҇୯΋ԭԃϤДΒΜΖВ.

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(4) Ҟᒵ ಃ΋കʳ ߻‫ ق‬----------------------------------------------------------------------- 01 ಃΒകʳ Ў᝘௖૸ ----------------------------------------------------------------- 04 ಃ΋࿯ʳ Ѡ᡼Ӽჱྣៈ‫ޑ‬ᙁўᆶᆒઓ ---------------------------------- 04 ಃΒ࿯ʳ Ӽჱੰ‫܊‬ᕎ҃ੰ஻த‫ޑـ‬ဉगੱ‫ރ‬ϷวғচӢ------------- 06 ಃΟ࿯ʳ Ջᙴჹᕎ҃Ӽჱੰ‫ੰ܊‬஻ߡઝੱ‫ݯޑރ‬ᕍ ------------------ 09 ಃѤ࿯ʳ ύᙴჹߡઝੱ‫ݯޑރ‬ᕍ ------------------------------------------ 12 ಃϖ࿯ʳ Ӽჱੰ‫܊‬ᕎ҃ੰ஻ߡઝϷဉगੱ‫ޑރ‬ຑ՗π‫ ڀ‬------------ 18 ಃΟകʳ ‫׷‬਑ᆶБ‫ ݤ‬-------------------------------------------------------------- 22 ಃ΋࿯ʳ ኬҁᒧ‫ڗ‬ᆶϩಔ --------------------------------------------------- 22 ಃΒ࿯ʳ ᖏ‫׉‬၂ᡍ൑‫ ܌‬------------------------------------------------------ 23 ಃΟ࿯ʳ ᖏ‫׉‬၂ᡍҔᛰϷϟಏ --------------------------------------------- 23 ಃѤ࿯ʳ ᖏ‫׉‬ჴᡍБ‫ݤ‬Ϸࢬำ --------------------------------------------- 27 ಃϖ࿯ʳ ᖏ‫׉‬၂ᡍၗ਑ϩ‫݋‬಍ी ------------------------------------------ 28 ಃѤകʳ ่݀ ----------------------------------------------------------------------- 29 ಃ΋࿯ʳ ‫ڙ‬၂‫୷ޣ‬ҁၗ਑ --------------------------------------------------- 29 ಃΒ࿯ʳ ‫ڙ‬၂‫ޣ‬ϐ٬ҔՋᛰ೬ߡᏊϷЗภᏊ่݀ϩ‫ ݋‬--------------- 29 ಃΟ࿯ʳ ȬӼჱྣៈࠔ፦ᅱ௓ࡰ኱ȭϐӚ໨ୖኧၗ਑ϩ‫ ݋‬--------- 34 ಃѤ࿯ʳ Ȭᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ȭၗ਑ϩ‫ ݋‬------------------ 39. iv.

(5) ಃϖ࿯ʳ Ȭғࢲࠔ፦ຑ՗߄ȭၗ਑ϩ‫ ݋‬--------------------------------- 41 ಃϖകʳ ૸ፕ ----------------------------------------------------------------------- 42 ಃϤകʳ ่ፕ ----------------------------------------------------------------------- 46 ୖԵЎ᝘ --------------------------------------------------------------------------- 47 ߕᒵ 1ǵ ȬӼჱྣៈ၂ᒤीฝȭࠔ፦ᅱ௓ࡰ኱ ------------------------------ 52 ߕᒵ 2ǵӼჱੰ‫܊‬ϐ१ኅόਁຑ՗ໆ߄---------------------------------------- 57 ߕᒵ 3ǵᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄------------------------------------------- 59 ߕᒵ 4ǵғ‫ࠔڮ‬፦ຑ՗߄--------------------------------------------------------- 61 ߕᒵ 5ǵӕཀᖏ‫׉‬၂ᡍ᛾ܴਜ--------------------------------------------------- 62 मЎᄔा --------------------------------------------------------------------------- 64. v.

(6) კҞᒵ კ 3.1 ε໳ࣽᏢύᛰკ --------------------------------------------------------- 25 კ 3.2 ε໳ HPLC კ ----------------------------------------------------------- 25 კ 3.3 Ғ૛ࣽᏢύᛰკ --------------------------------------------------------- 26 კ 3.4 Ғ૛ HPLC კ ----------------------------------------------------------- 26 კ 4.1 ჴᡍಔϐ೬ߡᏊ٬Ҕ௃‫ ׎‬--------------------------------------------- 31 კ 4.2 ჹྣಔϐ೬ߡᏊ٬Ҕ௃‫ ׎‬--------------------------------------------- 32 კ 4.3 ჴᡍಔϐЗภᏊ٬Ҕ௃‫ ׎‬--------------------------------------------- 32 კ 4.4 ჹྣಔϐЗภᏊ٬Ҕ௃‫ ׎‬--------------------------------------------- 33 კ 4.5 ٬Ҕ೬ߡᏊϷЗภᏊ่݀ኧᏵߏచკ ------------------------------ 33 კ 4.6 ‫ٿ‬ಔϐߡઝϩኧ่݀Кၨ --------------------------------------------- 36 კ 4.7 ‫ٿ‬ಔϐߡઝϩኧ่݀Кၨ --------------------------------------------- 37 კ 4.8 ‫ٿ‬ಔϐ१ኅόਁϩኧ่݀Кၨ --------------------------------------- 37 კ 4.9 ‫ٿ‬ಔϐ१ኅόਁϩኧ่݀Кၨ --------------------------------------- 38 კ 4.10 ‫ٿ‬ಔϐဎ๞ϩኧ่݀Кၨ -------------------------------------------- 38 კ 4.11 ‫ٿ‬ಔϐဎ๞ϩኧ่݀Кၨ -------------------------------------------- 39. vi.

(7) ߄Ҟᒵ ߄ 2.1 ߡઝวғёૈচӢ ------------------------------------------------------ 10 ߄ 2.2 ՋᛰதҔ೬ߡᏊ Laxatives --------------------------------------------- 11 ߄ 3.1 ᖏ‫׉‬၂ᡍࢬำ-------------------------------------------------------------- 24 ߄ 4.1 ‫ڙ‬၂‫୷ޣ‬ҁၗ਑----------------------------------------------------------- 30 ߄ 4.2 ဉगੱ‫ރ‬ໆ߄Ӛ໨ୖኧϩ‫݋‬Ȑ҂௨ନሷगᆅȑ-------------------- 35 ߄ 4.3 ဉगੱ‫ރ‬ໆ߄Ӛ໨ୖኧϩ‫݋‬Ȑ௨ନሷगᆅȑ ------------------------ 36 ߄ 4.4 ᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ၗ਑ϩ‫ ݋‬------------------------------ 40 ߄ 4.5 ғࢲࠔ፦ຑ՗߄่݀ϩ‫ ݋‬--------------------------------------------- 41. vii.

(8) ߕҹҞᒵ ߕᒵ 1ǵ ȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱ ----------------------------- 52 ߕᒵ 2ǵӼჱੰ‫ੰ܊‬஻ϐ१ኅόਁຑ՗ໆ߄ ------------------------------- 57 ߕᒵ 3ǵᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ (EORTC QLQ-C30 V3.0)--------- 59 ߕᒵ 4ǵғࢲࠔ፦ຑ՗߄ ECOG: Eastern Cooperative Oncology Group Performance Status). ------------------------------------------------------------ 61. ߕᒵ 5ǵӕཀᖏ‫׉‬၂ᡍ᛾ܴਜ-------------------------------------------------- 62. viii.

(9) ε໳Ғ૛෯‫ׯ‬๓Ӽჱੰ‫ੰ܊‬஻ ߡઝੱ‫ރ‬ϐӃ០ࣴ‫ز‬ ύ୯ᙴᛰεᏢύ୯ᙴᏢࣴ‫܌ز‬ ࡰᏤ௲௤ ݅ࡿ۪ ௲௤ ࣴ‫ز‬ғ. ቅ‫ػ‬ቺ. ᄔा ߡઝჹ‫ܭ‬ᕎ҃ੰ஻Զ‫ق‬Ǵࢂ΋ᅿදၹӸӧЪᝄख़‫ޑ‬ୢᚒǴ࿶த೷ ԋੰΓ᏾ᡏ‫ޑݩރ‬ൾϯǴΨ೷ԋੰ஻ৎឦཱུε‫ޑ‬ขቾ 1-2Ƕᕎ҃ੰΓǴ җ‫ੵܭ‬ภ‫ރੱޑ‬Ǵ٩Ӽჱྣៈচ߾Ǵ๏ϒαܺ‫܈‬ଞᏊ༏ଢ଼ᜪЗภᏊǴ Ψ৒ܰ೷ԋߡઝǵ१ኅό٫‫܈‬ဎ๞฻ੱ‫ރ‬Ǵᖏ‫׉‬΢٬Ҕ Laxative ‫ݯ‬ᕍ ߡઝǴਏ݀Ԗਔόܴᡉ 3-4Ƕ ҁࣴ‫ࣁز‬ᒿᐒൂ‫ޓ‬Ӄ០‫زࣴ܄‬Ǵԏਢੰ஻ࣁᄆϯ୷࿎௲ᙴଣӼჱ ੰ‫܊‬ᕎ҃ੰ஻ǴᕴӅԏਢΓኧࣁ 27 ΓǴϩჴᡍಔᆶჹྣಔ຾Չᖏ‫׉‬ ၂ᡍǶ ҁࣴ‫ز‬๏ϒፄБύᛰε໳Ғ૛෯Ǵ‫؂‬Вғε໳ 2 լϷғҒ૛ 0.5 լǴϩԋѤԛ๏ᛰǴࣁයϤϺǶຑ՗π‫ڀ‬ᒧҔȨӼჱྣៈ၂ᒤीฝȩ ࠔ፦ᅱ௓ࡰ኱ 5ǵᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ (EORTC QLQ-C30 -1-.

(10) V3.0)6 Ϸғࢲࠔ፦ຑ՗߄ (ECOGǺEastern Cooperative Oncology Group Performance Status)Ƕ ҁࣴ‫่݀ز‬ว౜Ǵჴᡍಔ๏ϒε໳Ғ૛෯ܴᡉ‫ׯ‬๓ߡઝǵ१ኅό ਁϷဎ๞ੱ‫ރ‬Ǵ٠ၲ‫ډ‬಍ीᏢ΢‫ޑ‬ཀကǶ. ᜢᗖຒǺߡઝ (constipation)Ǵᕎ҃ (terminal cancer)Ǵε໳Ғ૛෯ (Da Huang Gan Cao Tang)ǴӼჱᕍៈ (palliative care). -2-.

(11) ಃ΋ക ߻‫ق‬ ਥᏵШࣚፁғಔᙃ (WHO) ‫ޑ‬ၗ਑ǴӼჱᕍៈࢂࡰଞჹ‫ݯ‬ᘰ‫ݯ܄‬ ᕍคϸᔈϐ҃යੰ஻ග‫ٮ‬ᑈཱུ‫܄‬ϷӄΓϯ‫ ៝ྣޑ‬7ǴаᆢៈੰΓ‫ک‬ৎ ឦന٫‫ޑ‬ғ‫ࠔڮ‬፦ǹЬाࢂ೸ၸੵภ௓‫ڋ‬Ǵ጗෧‫ي‬ᡏ΢‫ځ‬дό፾‫ੱޑ‬ ‫ރ‬Ǵӕਔ٠ೀ౛ੰ஻ϷৎឦӧЈ౛ǵ‫ک཮ޗ‬Јᡫ΢‫ޑ‬ୢᚒǴΨ൩ࢂᇥ Ӽჱᕍៈ‫୷ޑ‬ᘵࡘԵǴࢂΚ‫ੰ؃‬ΓЬᢀ‫ׯ‬๓ࣁচ߾Ǵӧ౜жᙴᕍ‫ೌמ‬ ค‫ੰࣁݤ‬஻ග‫׳ٮ‬Ԗճ‫୍ܺޑ‬ϐሞǴӼჱᕍៈҔ൧ख़ғ‫ޑڮ‬ণᏢᄊ ࡋǴഉՔੰΓ‫و‬ၸΓғനࡕਓำǴ٠ᇶᏤৎឦख़ཥय़ჹ҂ٰ‫ޑ‬ғࢲǶ ߡઝӧӼჱᕍៈ΢Ǵࢂᖏ‫׉‬΢ࡐத‫ޑډـ‬ୢᚒǴ࿶த೷ԋੰΓӚ ᅿဉၰੱ‫ރ‬ǴЇଆੰΓ‫ޑ‬ဎ๞ǵ१ኅόਁǵੵภǴቹៜғࢲࠔ፦Ǵ᏾ ᡏ‫ޑݩރ‬ൾϯǴΨ೷ԋੰ஻ৎឦཱུε‫ޑ‬ขቾ 1-2, 8-9Ƕ಍ीѦ୯Ӽჱੰ ‫܊‬ǴԖ 50-80% ‫ੰޑ‬Γሡा٬Ҕ Laxative ‫ݯ‬ᕍߡઝǴԖ٤ੰΓϝ໪ ߏਔ໔٬Ҕឲဉೀ౛ߡઝୢᚒ 4, 10-11ǶӧѠ᡼Ψว౜‫܌‬ԖՐଣ‫ੰޑ‬Γ ύǴԖ 50%Ԗ௨ߡ֚ᘋǴԶᕎ҃ੰ஻Ǵҗ‫ੵܭ‬ภ‫ރੱޑ‬Ǵ٩Ӽჱྣៈ চ߾Ǵ๏ϒαܺ‫܈‬ଞᏊ༏ଢ଼ᜪЗภᏊǴੰΓวғ௨ߡ֚ᜤ௃‫׎‬ଯၲ 95%1, 4, 7Ƕ ੰΓ‫ߡޑ‬ઝୢᚒऩؒԖִ๓ೀ౛Ǵёૈ཮ᏤठੰΓ१ኅΠफ़Ϸဉ ᝸୏ᡂৡǴ‫׎‬ԋ΋ঁൾ‫܄‬ൻᕉǴᡣߡઝୢᚒ‫׳‬ᜤೀ౛Ǵᖏ‫׉‬΢ҭԖൔ ᏤǴੰΓ཮ӢࣁߡઝୢᚒԶྠចόӼǶᖏ‫׉‬΢ҭԖว౜ǴੰΓӢࣁᏼ. 1.

(12) Јߡઝ‫׳‬уൾϯǴԶ‫๊ܔ‬٬ҔЗภᛰǴ‫׳ڙ܍‬ӭภधǶҗԜёаܴᕕǴ ᖏ‫׉‬ᛰ‫ࡽނ‬όૈԖਏ‫ׯ‬๓ᕎ҃ੰΓ‫ߡޑ‬ઝୢᚒǴᗋ཮ቚуᙴᕍԋҁǶ ਥᏵ Fallon ‫ ک‬OȷNeill ჹ‫ߡܭ‬ઝ‫ۓޑ‬ကࢂǴࡰϿໆЪฯ‫ޑ‬ᕨ ߡǴόೕࡓЪ֚ᜤ௨р 12-13Ƕᖏ‫׉‬΢ǴΨё٩௨ߡ‫܄‬፦բࣁߡઝୖԵǴ ӢԜୖԵ Bristol ᕨߡ‫܄‬፦ໆ߄ஒ௨ߡ‫܄‬፦ϩԋ೬‫ރݝ‬ǵѳྖచ‫ރ‬ǵό ѳྖచ‫ރ‬Ϸᗭಈ‫ރ‬Ǵ‫׆‬ఈੰΓ‫ޑ‬௨ߡૈև౜೬‫ރݝ‬ǵѳྖచ‫ ރ‬14ǶԶ ᕎ҃ੰΓр౜ߡઝ‫ޑ‬চӢԖ٬ҔЗภᛰǵࢲ୏ࡋᡂৡϷ१‫ނ‬ύલЮᠼ ᆢ፦฻฻ 15Ƕᖏ‫׉‬΢‫ݯ‬ᕍߡઝ‫ޑ‬ೀ࿼х֖ᛰ‫ނ‬Ϸߚᛰ‫ݯނ‬ᕍǴԖ٤ੰ Γ٬Ҕᛰ‫ݯނ‬ᕍਏ݀ϝฅό٫Ǵ࿶தሡाаߟΕ‫ޑ܄‬ឲဉϷࡰບٰ‫ڐ‬ շ௨ߡǴՠ՟Яค‫ֹݤ‬ӄ‫ׯ‬๓ੰΓ‫ݩރ‬ǴϸԶ৒ܰ٬ੰΓߡઝǵဎᘞ ፺ࢬҬඹр౜ǴࣗԿЇวεߡѨ࿣Ǵ‫ي‬Јഢ‫ྞڙ‬ዖ 16Ƕ Չࡹଣፁғ࿿‫ܭ‬ΖΜѤԃଆ໒‫ۈ‬௢୏ӼჱᕍៈीฝϷु‫ۓ‬Ӽჱᕍ ៈੰ‫܊‬೛࿼ୖԵೕጄǴύѧ଼நߥᓀֽҭԾΖΜϖԃଆஒӼჱۚৎྣ ៈયΕ၂ᒤीฝǴԶ᏾ᡏ၂ᒤीฝ‫ܭ‬ΖΜΐԃΎД໒‫ۈ‬ჴࡼǴ‫ୖॺך‬ ԵȬӼჱᕍៈ᏾ӝ‫ྣ܄‬ៈયΕӄ଼҇நߥᓀ๏б၂ᒤीฝȭ5 ྽ύ‫ޑ‬ᆒ ઓǴаӄΓྣ៝ኳԄࣁЬ‫ޑ‬Ӽჱᕍៈྣៈᕎੱ҃යੰ஻Ǵ٠ၮҔ྽ύ ‫ޑ‬ȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱Ǵ຾Չԏਢੰ஻‫ޑ‬ဉगфૈࡰ ኱ᅱෳǶ Զӧӄ଼҇நߥᓀֽ‫ڐޑ‬շΠǴ‫ ܭ‬98 ԃࡋঅुȨՋᙴՐଣੰ஻ ύᙴᇶշᙴᕍ၂ᒤीฝȩύჴՉ໨ҞǴуΕȬဍዦੰ஻Ћೌǵϯᕍǵ 2.

(13) ‫ܫ‬৔ጕᕍ‫ࡕݤ‬ՋᙴՐଣੰ஻ύᙴᇶշᙴᕍ၂ᒤीฝȭ ǹ‫ ܭ‬99 ԃ٩ჴՉ ԋਏǴӆՉঅुीฝӜᆀࣁȬဍዦੰ஻Ћೌǵϯᕍǵ‫ܫ‬ጕ৔ᕍ‫ݤ‬Ջᙴ Րଣੰ஻ύᙴᇶշᙴᕍ၂ᒤीฝȭǶ٠‫ ܭ‬100 ԃਔӆࡋঅ‫ۓ‬ǴࣁȬӄ ଼҇நߥᓀဍዦੰ஻Ћೌǵϯᕍǵ‫ܫ‬৔ጕᕍ‫ࡕݤ‬ՋᙴՐଣੰ஻ύᙴᇶ շᙴᕍ၂ᒤीฝȭ17Ƕीฝ‫ޑ‬ЬाҞ‫ޑ‬Ǵࢂ‫׆‬ఈ೸ၸύՋᙴ่ӝ‫ݯޑ‬ ᕍБԄǴஒဍዦੰ஻࿶Ћೌǵ‫ܫ‬ϯᕍࡕதр౜‫ޑ‬ဉगό፾ǵ੾ཀྵǵပ ᎳǴаϷᕍำύதр౜‫ޑ‬αଳǵα๚ውᅬǵߡઝǵဎᘞǵ஭α֚ᜤ฻ ੱ‫ރ‬෧ᇸ‫ډ‬നեǴᡣੰ஻ૈ໩ճֹԋ᏾ঁՋᙴᕍำǴวචനεᕍਏǹ Ѐ‫ځ‬ჹ҃යੰ஻‫܌‬р౜‫ޑ‬ൾੰ፦Ǵፏӵᡏख़෧ᇸǴ१ኅόਁǴᆒઓ๺ ᜧ฻ό፾ǴаϷᕎ‫ੵ܄‬ภୢᚒǴ೸ၸύᙴ‫ޑ‬ᡏ፦ፓ౛Ǵගϲੰ஻‫ޑ‬ғ ࢲࠔ፦Ƕ ҁࣴ‫่ز‬ӝՋᙴȬӼჱᕍៈ᏾ӝ‫ྣ܄‬ៈયΕӄ଼҇நߥᓀ๏б၂ ᒤीฝȭϷύᙴȬӄ଼҇நߥᓀဍዦੰ஻Ћೌǵϯᕍǵ‫ܫ‬৔ጕᕍ‫ࡕݤ‬ ՋᙴՐଣੰ஻ύᙴᇶշᙴᕍ၂ᒤीฝȭ‫ٿ‬၂ᒤीฝ‫ޑ‬ᆒઓǴ຾Չᖏ‫׉‬ ၂ᡍǶ. 3.

(14) ಃΒക Ў᝘௖૸ ಃ΋࿯. Ѡ᡼Ӽჱྣៈ‫ޑ‬ᙁўᆶᆒઓ. Ӽჱᕍៈ (Hospice) ࢂྍԾύШइਔжǴ଺ࣁරဃ‫܈ޣ‬ਓՉ‫ޣ‬ύ ೼Ҷ৲ǵख़ཥံ‫ى‬ᡏΚ‫ޑ‬ᡌઠǴӕਔΨග‫ٽې៝ྣٮ‬ǵ೦҇ǵੰΓǵ ᖏಖ‫ޣ‬ϐ୍ܺǶ‫ܭ‬ΜΐШइǴՋБ୯ৎഌុԋҥӼჱᕍៈᐒᄬǴྣ៝ ᖏಖੰ஻ 18Ƕ ߈жӼჱᕍៈ‫ ܭۈ‬1967 ԃǴҗम୯ਬቺํᙴৣ (Dr. Dame Cicely Saunders) ‫ܭ‬म୯উඩ߈॓೛ҥဃլ㚊ථӭᅽӼჱଣ (St. Christopherȷs Hospice)ǴࣁӄШࣚಃ΋‫܌‬ӼჱᕍៈᙴଣǴ௦‫ڗ‬ᙴᕍი ໗ӝբБԄྣ៝ᕎੱ҃යੰ஻Ǵ෧ᇸੰΓϷৎឦภधǴ٠ഉՔдॺ‫و‬ ֹғ‫ڮ‬ӄำǶԿԜǴᖏಖᜢᚶ‫ޑ‬᝼ᚒǴӧ೚ӭ୯ৎ࣬ᝩว৖Ǵӧӄౚ 40 ӭঁ୯ৎ‫ک‬Ӧ୔৖໒ǶᖏಖᜢᚶǵӼჱᕍៈ‫ޑ‬౛‫ۺ‬ǴϷኳԄǴుు ӦቹៜϞВଯࣽ‫מ‬Ꮴӛ‫ޑ‬ᙴᏢǴՠϝԖࡑոΚ 19Ƕ ٩ᏵШࣚፁғಔᙃ (WHO) ‫ۓޑ‬ကǴӼჱᕍៈࢂࡰჹ‫ܭ‬ค‫ݯݤ‬ ᘰ੯ੰϐ҃යੰΓǴ௦‫ڗ‬ӄΓϯྣ៝ǴаᆢៈੰΓ‫ک‬ৎឦന٫‫ޑ‬ғ‫ڮ‬ ࠔ፦ǹ೸ၸੵภ௓‫ڋ‬Ǵ෧጗‫ي‬ᡏ΢Ϸ‫ځ‬дό፾‫ރੱޑ‬Ǵ٠ӕਔೀ౛ੰ ஻ϷੰৎӧЈ౛ǵ‫ک཮ޗ‬Јᡫ΢‫ޑ‬ୢᚒǴ‫ࢂܭ‬চวੰ‫ݯޑ‬ᕍཀကࢂό ε‫ޑ‬ǴࣗԿ཮ቚуੰ஻‫ޑ‬ภधǶ‫܌‬аǴӼჱᖏಖᜢᚶ‫ޑ‬Ҟ‫ࢂޑ‬Ǻ1ǵ௓. 4.

(15) ‫ރੱڋ‬Ǵ጗ှ‫੃܈‬ନੰΓ‫ޑ‬ภधǹ2ǵᔅշ҃යੰΓᕕှཥഋжᖴೕࡓǴ ੃ନᖏಖ৮ឨǹ3ǵ๏ϒੰΓϷৎឦЈ౛΢Ϸᆒઓ΢‫ޑ‬Ѝ࡭Ƕ ӧѠ᡼ǴԾ 1990 ԃ 2 ДǴҗଭିइ‫ۺ‬ᙴଣ఩НϩଣǴԋҥಃ΋ ঁӼჱੰ‫܊‬ǹ1995 ԃ 10 ДǴ Ȩύ๮Ӽჱྣៈ‫཮ڐ‬ȩԋҥǴаϷ 1999 ԃȨѠ᡼Ӽჱ጗‫ک‬ᙴᏢᏢ཮ȩ‫ޑ‬ԋҥǴ൚‫ۓ‬ΑӼჱᕍៈӧѠ᡼‫ޑ‬Ꮲೌ ӦՏǶ2000 ԃǴፁғ࿿҅Ԅ௢ՉӼჱᕍៈຑ՗߄ǵӼჱ጗‫ک‬చ‫ٯ‬Ϸᕎ ҃࣬ᜢᆛઠǶѠ᡼‫ޑ‬Ӽჱᕍៈว৖Ǵς࿶ຬၸΑΒΜԃǴӧၸѐǴՋ ᙴ጗‫ک‬ᙴᕍӃ຾ॺǴոΚӦ৖౜ΑӼჱ጗‫ک‬ᙴᕍԖձ‫ځܭ‬дᙴᕍሦୱ ੝ՅǴ٠ठΚ‫ܭ‬ගϲᖏಖੰΓྣៈϷৎឦ‫ޑ‬ғࢲࠔ፦ǶջߡӵԜǴѠ ᡼‫ޑ‬Ӽჱᕍៈπբว৖ϝฅࢂั጗ᄌ‫ޑ‬Ǵᖏ‫׉‬΢ᢀჸǴε೽ϩ‫ޑ‬ᕎੱ ҃යᖏಖੰ஻ǴϝӭэՐ࡚‫܊ੰ܄‬Ǵࡼϒᑈཱུ‫ݯ‬ᘰ‫ݯ܄‬ᕍǴߚՠੰΓ ภधǴৎឦ੮Π҉ᇻ‫ޑ‬ᒪᏬǴΨੁ຤೚ӭόѸा‫ޑ‬ᙴᕍၗྍǶਥᏵՉ ࡹଣፁғ࿿‫ޑ‬಍ीၗ਑Ǵ୯ϣҞ߻‫؂‬ԃऊԖΟ࿤Γԝ‫ܭ‬ᕎੱǴՠ‫؂‬ԃ ௗ‫ڙ‬Ӽჱᕍៈྣៈϐੰ஻ΓኧऊѝԖΟίԿϖίΓǴѝэᕎੱԝΫΓ α‫ޑ‬Μϩϐ΋Ǵ‫ٮ‬ሡϝόѳᑽǶਥᏵ୯Ѧ࣬ᜢࣴ‫ز‬ᡉҢǴӵаӄΓྣ ៝ࣁЬ‫ޑ‬Ӽჱᕍៈྣៈᕎੱ҃යੰ஻Ǵόՠૈග‫ٮ‬ၨࣁΓ‫܄‬ϯ‫ޑ‬ᙴᕍ ୍ܺǴᙴᕍ຤Ҕҭૈε൯फ़եǶ Ԗ᠘‫ܭ‬ԜǴՉࡹଣፁғ࿿‫ܭ‬ΖΜѤԃଆ໒‫ۈ‬௢୏ӼჱᕍៈीฝϷ ु‫ۓ‬Ӽჱᕍៈੰ‫܊‬೛࿼ୖԵೕጄǴύѧ଼நߥᓀֽҭଛӝԾΖΜϖԃ. 5.

(16) ଆஒӼჱۚৎྣៈયΕ၂ᒤीฝǴԶ᏾ᡏ၂ᒤीฝ‫ܭ‬ΖΜΐԃΎД໒ ‫ۈ‬ჴࡼǴ٠ϩձ‫ܭ‬ΐΜΟԃϡДϷΐΜϖԃϡДǴ຾Չीฝϐ΋‫ހ‬Ϸ Β‫ހ‬ϐঅुǶ ಃΒ࿯. Ӽჱੰ‫܊‬ᕎ҃ੰ஻த‫ޑـ‬ဉगੱ‫ރ‬ϷวғচӢ. ΋ǵߡઝǺߡઝჹόӕ‫ޑ‬ΓԖόӕ‫ޑ‬ཀကǶჹࢌ٤ੰ஻Զ‫ق‬Ǵߡ ઝཀࡰᕨߡϼฯ‫܈‬ϼϿǹ‫ࢂ܈‬௨ߡ֚ᜤ‫ࢂ܈‬όத௨ߡǶଞჹ߻य़Οᅿ চӢǴᖏ‫׉‬΢ၨᜤ‫܄ۓ‬ǴԶଞჹ௨ߡᓎ౗Զ‫ق‬Ǵࢂёа೏ໆϯϷෳໆ ‫ޑ‬ǶਥᏵ Fallon ‫ ک‬OȷNeill ᇡࣁߡઝ‫ۓޑ‬ကࢂǴࡰϿໆЪฯ‫ޑ‬ᕨߡǴ όೕࡓЪ֚ᜤ௨рǶԶ݅ችЎ 20 ࡰрߡઝ‫ۓޑ‬ကǴх֖ᓎ౗Ǻ΋ࢃය ค‫ݤ‬௨ߡΟԛ‫܈‬ှߡԛኧϿ‫ੰܭ‬Γ۳தಞᄍǹ௨ߡਔҔΚਔ໔эѐ‫܌‬ Ԗεऊ 25% ‫ޑ‬ਔ໔ǴϷ௨ߡ‫ޑ‬ਔ໔ε‫ ܭ‬10 ϩដа΢Ƕᖏ‫׉‬΢ǴΨё ٩௨ߡ‫܄‬፦բࣁߡઝୖԵǴӢԜୖԵ Bristol ௨ߡ‫܄‬፦ໆ߄ஒ௨ߡ‫܄‬ ፦ϩԋ೬‫ރݝ‬ǵѳྖచ‫ރ‬ǵόѳྖచ‫ރ‬Ϸᗭಈ‫ރ‬Ǵ‫׆‬ఈੰΓ‫ޑ‬௨ߡૈ և౜೬‫ރݝ‬ǵѳྖచ‫ރ‬ǶӼჱྣៈύ‫ڀ‬Ԗߡઝੱ‫ޑރ‬ᕎ҃ੰ஻Ǵӕਔ ཮Ԗဎภǵ⧋ЈǵჍӗǵဎᘞϷဉ᝸୏֚ᜤੱ‫ރ‬Ƕߡઝੰў೯தሡा Եቾԛભ‫׎‬ԋচӢǶჹᕎ҃ੰΓߡઝੱ‫ޑރ‬᠘ձບᘐ‫ރੱځ‬ЬाচӢ Ԗ 21Ǻ 1ǵᛰ‫ނ‬ӢનǺ‫ݯ‬ᕎੱᛰ‫ނ‬ǵ‫ל‬ᖌᡵᛰ‫( ނ‬AnticholinergicǺbuscopan) ᛰ‫ނ‬ǵ‫ל‬ኁᢠᛰ‫ނ‬ǵᎻТᜪЗภᛰϷ៓ᏊǶ 6.

(17) ӣ៝ੱ‫ރ‬চӢǴ‫ځ‬ύεऊԖ 30-50ʘ ‫ޑ‬ᎻТᜪЗภᛰ٬Ҕੰ஻ӧ ߃ය཮วғߡઝǵ⧋ЈǵჍӗ౜ຝ 10,21 Ǵ‫ځ‬ᛰ౛ᐒ‫ڋ‬ёૈࢂ‫ڋ׭‬ ဉग᝸୏೷ԋगဉ௨‫ޜ‬ምᛖϷߡઝӕਔ‫ڈ‬ᐟ‫ۯ‬တჍӗύኰ CZT centerǶ΋ጇӣྉࠠࣴ‫ز‬ᡉҢǴ๏ϒӼჱᕍៈੰ஻ᎻТᜪҔᛰЗภ ᛰ‫܈‬ЗӗᏊਔǴӕਔ๏ϒ፾྽‫ޑ‬೬ߡᏊೀБǴૈԖਏӦ‫ׯ‬๓Ӽჱ ᕎ҃ੰΓ‫ޑ‬ғࢲࠔ፦ 22ǶԖࣴ‫ز‬ᡉҢǴԖ࣬྽εК‫ޑٯ‬ᕎੱੰ஻ ٬ҔαܺᎻТᜪҔᛰЗภᛰǴ֡೷ԋߡઝୢᚒǴԶ೭٤ߡઝੱ‫ރ‬Ǵ ೯த‫ݯ‬ᕍਏ݀೿ό٫ 23Ƕ 2ǵߚᛰ‫ނ‬ӢનǺӵኁᢠੱǵಥНǵଯՈ້Ϸ१ኅόਁ฻Ƕ Βǵ⧋ЈǵჍӗǺ೷ԋᕎ҃ੰ஻⧋ЈǵჍӗ‫ޑ‬চӢхࡴǺ 1ǵНϩ‫ک‬ႝှ፦‫ޑ‬ѳᑽѨதǴӵଯՈ້Ƕ 2ǵ౦தಥН౜ຝǶ 3ǵᛰ‫ނ‬բҔǴӵϯᕍǵᎻТᜪЗภᛰ‫לک‬ғન‫ޑ‬٬ҔǶ 4ǵगဉфૈምᛖǴӵगᇸᡛ (gastroparesis)ǵगᓸॐ (gastric compression) Ƕ 5ǵύኰઓ࿶ӢનǴӵᕎੱတᙯ౽ǵขቾǵ߻৥фૈምᛖ (vestibular dysfunction) Ƕ 6ǵൾ‫܄‬ᕎੱǴӵ‫ط‬ᕎǵတᕎǶ 7ǵགࢉǴӵ௳ՈੱǶ. 7.

(18) 8ǵ‫ܫ‬৔ጕ‫ݯ‬ᕍǶ Οǵ१ኅόਁǺ१ኅόਁࢂᄌ‫܄‬ੲ॰ǵ⧋Јǵαଳੱ‫ߡޣ܈‬ઝ‫่݀ޑ‬Ƕ ᠘ձບᘐх֖ԖǺ 1ǵဉၰό᝸୏Ƕ 2ǵᛰ‫ނ‬ቹៜǴӵӼߚд‫ڮ‬ᜪǵ‫ל‬ғનᜪǵ‫ל‬ಔᙃữᜪǵЛӦ໳ᜪϷ ranolazine ᜪҔᛰǶ 3ǵኁᢠǶ 4ǵჇ१ੱǶ ѤǵဎᘞǺᕎ҃ੰ஻ဎᘞ‫ޑ‬চӢऊԖΠӈ൳ᅿǺ 1ǵ੯ੰǺᕎ҃ੰ஻ဉၰ೏ઇᚯǴόૈԖਏӦӆ֎ԏဉၰ‫ޑ‬НϩǴӆ у΢ᔼᎦό‫ࢂ׳ؼ‬৒ܰԖဎᘞ‫ރੱޑ‬Ƕӵ଑ဉ೏Ϫନ‫ੰޑ‬ΓǴӢ ค‫ݤ‬Ь୏֎ԏᖌለǴΨ཮೷ԋᖌҊဎᘞǶ 2ǵᛰ‫ނ‬Ǻ཮೷ԋဎᘞ‫ޑ‬ᛰ‫ނ‬ӵ‫ݯ‬ᕎᛰӵ FlurouracilǵIrinotecanǵߚ ᜪ‫ڰ‬ᎇᜪ੃‫ݹ‬ᛰ NSAIDSǵ‫ڋ‬ለᏊ (magnesium hydroxide) ‫ܫ܈‬৔ ‫ݯ‬ᕍ฻฻ǶԶεໆ٬ҔᘞᏊ‫ ࢂ܈‬sorbitol ᜪᛰ‫ނ‬Ǵ೷ԋဉၰ᝸୏ ၸ‫܈ז‬ဉၰϣᅖ೸ᓸϼଯǴΨ཮೷ԋဎᘞǶ 3ǵ१‫ނ‬Ǻឪ‫ڗ‬ၸӭᠼᆢન‫܈‬ၸӭН݀‫܈‬ϼ‫ݨ‬१‫ނ‬ǴΨ཮೷ԋဎᘞǶ. 8.

(19) ಃΟ࿯. Ջᙴჹᕎ҃Ӽჱੰ‫ੰ܊‬஻ߡઝੱ‫ݯޑރ‬ᕍ. ӧӼჱᕍៈύǴᕎ҃ੰΓ‫ߡޑ‬ઝੱ‫ރ‬Ǵਔத೷ԋੰ஻‫׳‬уྞዖᆶ ό፾Ƕࣴ‫ز‬ᡉҢǴග‫׳ٮ‬మཱǵ‫׳‬ԖਏҔ‫ޑ‬ᖏ‫ݯ׉‬ᕍࡰЇǴຫٰຫ‫ڙ‬ ‫ډ‬ख़ຎǴ٠ЪႴᓰ຾΋‫؁‬ӧ೭ঁ᝼ᚒ΢Ǵ຾Չ຾΋‫ޑ؁‬ᖏ‫׉‬၂ᡍࣴ‫ز‬ 9. Ƕᖏ‫׉‬΢Ǵ΋૓ߡઝ‫ޑ‬চӢǴёаᏤӢ‫ܭ‬ᛰ‫ނ‬Ӣન‫ࢂޣ܈‬Ꮤ‫܈܄۔‬ф. ૈ‫܄‬Ӣન 1-2, 4ȐӵΠ߄ 2.1ȑǶ ऩᛰ‫ࢂނ‬೷ԋߡઝ‫ޑ‬ЬӢǴٗሶԖϙሶБԄёа೷ԋ‫ي‬ᡏϣѳᑽǴҭ ‫ࢂ܈‬೭٤๏ᛰѸ໪ଶЗǶඤ‫ق‬ϐǴੰ஻ჹᎻТᜪЗภᛰ‫ޑ‬ϸᔈ൩ࡐৡǶ ӢԜǴᒿ๱ᎻТᜪЗภᏊ‫ޑ‬๏ϒਔǴႣٛ‫܄ុ࡭܄‬Ӧ๏ϒ೬ߡᏊ (Laxatives) ൩࣬ჹѸሡǶӕਔǴଯᠼ໯१ǵቚуНҽឪ‫ڗ‬٠፾ࡋ‫ޑ‬ቚ у‫ي‬ᡏࢲ୏ǴӧӼჱੰΓ‫ޑ‬ᖏ‫ྣ׉‬ៈ೛ी΢Ǵ࣬ჹόϼૈ୼ჴՉǶࢂ аՋᙴᖏ‫ྣ׉‬ៈ΢Ǵ೬ߡᏊ (Laxatives) ‫ޑ‬๏ϒ൩٩ྣᕎ҃ੰ஻྽ਔ ᖏ‫ރੱ׉‬Զ‫ۓ‬Ƕ߄ 2.2 ࢂᖏ‫׉‬΢தҔ೬ߡᏊ (Laxatives)Ƕ. 9.

(20) ߄ 2.1ǵߡઝวғёૈচӢ Ꮤ‫܄۔‬Ӣન. фૈ‫܄‬Ӣન. ᛰ‫ނ‬ᇨวӢન. Ꮸ࠻‫ݹ‬. ่ဉ௨‫ߏۯޜ‬. ᎻТᜪҔᛰ. ဍዦ. ௨ߡ֚ᜤ. ‫ל‬ғન. ‫ߐع‬ೀว‫ݹ‬. నᡏឪ‫ڗ‬ό‫ى‬. ‫ל‬ᖌᡵᛰ‫ނ‬. ઓ࿶‫܄‬੯ੰ. եᠼ१‫ނ‬. ଯՈᓸᛰ. ϣϩ‫ݜ‬੯ੰ. ဉ᝸୏֚ᜤ. ‫ל‬ᡜ⻯ᛰ. ཥഋжᖴӢન. ‫ל‬ኁᢠᛰ. ‫ޔ‬ဉ-‫ߐع‬੯ੰ. ‫ߎۦݯ‬හੱҔᛰ. Ѯ่ဉੱ. ճֿᏊ ઓ࿶‫ڋ׭‬Ꮚ ‫ڋ‬ለᏊ. 10.

(21) ߄ 2.2ǵՋᛰதҔ೬ߡᏊ Laxatives բҔኳԄ. ᅿᜪ. Bulking agents Saline laxatives ᡵᡶᘞᛰ Hyperosmotic laxatives. Antiresorptive and hydragogue laxatives. Sugar alcohols. Ꮚໆ. ਔ໔(λਔ). ഝᎽ. 10-30 mg. ߃‫ ۈ‬24-72ǹ ࡕ 8-24. ౷ለᗔǹ౷ለય. 10-20 g. 2-8. 1 ឲဉᏊ. 0.5-2. Mannit/mannitol Sorbitol/glycerol. ߃‫ ۈ‬10-72ǹ ࡕ 8-24 ߃‫ ۈ‬48-72ǹ ࡕ 8-24. Lactulose ٢݀ᑗ. 10-40 g. Macrogol 3350. 13-40 g. Sennoside B. 2–3 pills. Phenolphthalein. Bisacodyl. 10mg. Castor oil ⣽ഞ‫ݨ‬. Sodium picosulfate. 15–40 drops. 2–4 (–8). 4–6 g. 2–6. 25–50mg. 12–48 8–12. Sorbitol. 10–30 ml 1 ឲဉᏊ. 0.5–1. Glycerol. 1 ਵᏊ. 0.5–1. Sugar Polyethylene glycol Anthraglycoside. Castor oil Docusate sodium Paraffin. Lubricants. Laxatives with effect on the defecation reflex. ϣ֖‫ނ‬. Alcohols. 11. 12 Per orem 5–10, per rectum 15–60 min.

(22) ಃѤ࿯. ύᙴჹߡઝੱ‫ݯޑރ‬ᕍ. ύᙴ‫ݯ‬ᕍߡઝ‫ޑ‬ୢᚒǴӧђ‫ڂ‬ᙴਜς࿶Ӹӧ࣬྽Φᇻ‫ޑ‬ਔ໔Ǵӧ Ƞનୢɡᡫើஏ‫ڂ‬ፕȡύ૶ၩǺ Ȩεဉ‫ޣ‬Ǵ໺ၰϐ‫۔‬ǴᡂϯрోǶȩ໯ १‫ޑ‬ᆒ๮Ǵ࿶ၸग‫ޑ‬ϩှϷλဉ‫֎ޑ‬ԏϐࡕǴഭᎩ‫ޑ‬१‫ූނ‬෦೸ၸε ဉ‫ޑ‬໺ᏤǴଌрᡏѦ 24Ƕ ᐕжύᙴЎ᝘ჹߡઝ֡Ԗ࣬྽၁ᅰ૶ၩǶ Ȭ໳ࡆϣ࿶ȭᆀࣁȨεߡ ᜤȩ ǹ Ƞ໾ൣᚇੰፕȡύǴϩࣁȨ໚่ȩ ǵ Ȩ഍่ȩаϷȨ๠ऊȩ ǶࡕШᙴ ৎǴԖȨ॥ǵ਻ǵൣǵ዗ǵᔸઝȩϷȨ॥዗ᔿȩ฻ᏢᇥǶ΋‫ډޔ‬Αమ жȠᚇੰྍࢬชᐜȡǴω२‫ـ‬ȨߡઝȩੰӜ 24Ƕ ߡઝ‫ੰޑ‬ӢǴӚᙴৎ่ӝԾρ‫ޑ‬ᖏ‫׉‬࿶ᡍǴჹҁੰੰӢੰᐒ‫ޑ‬ᇡ ᛽ӚԖୁख़Ƕླྀम 25-26 ᇡࣁǴ‫ط‬Ѩ౧‫߾ݧ‬ग‫ޑ‬फ़ᐜфૈѨதԶܰठߡ ઝǹऩ‫ط‬Ոǵ‫ط‬഍ό‫ى‬Ǵ߾ဉၰѨዎߡଳǶΞӢ๝љΒߡǴࣁӃϺϐ ҁǴΏϡ഍ǵϡ໚ϐ۬Ǵεဉ௨‫ݧ‬ᕪಊ‫ޑ‬фૈԖᒘ‫ܭ‬๝‫ྦྕޑ‬ᔶᎦǶ ࡺவ౛‫ط‬෷๝ΕЋ‫ݯ‬ᕍᄌ‫܄‬фૈ‫ߡ܄‬ઝǶђᝩआ 27 ᇡࣁǴᖌ਻ό౧Ǵ ೯फ़Ѩத‫܈‬ᖌҊόᄣǴဉ๜όճёठߡઝǶߋቆ᎔ǵ‫׵‬୯ෂ 28-30 ᇡࣁǴ ‫ݯ‬ᕍߡઝ‫ޑ‬ၸำύाख़ຎՈ྿ੰᐒǴЀ‫ࢂځ‬ჹ‫ܭ‬Ⴄ‫ߡ܄ڰ‬ઝǴ‫׫‬аࢲ Ոϯ྿ϐࠔӭԏ‫ڻ‬ਏǶ‫ۏ‬౺ඵ฻ 31 ᇡࣁǴфૈ‫ߡ܄‬ઝ‫܈‬Ӣ๠‫਻ޤ‬຀Ǵ ၮϯѨᙍǴᏤठεဉ໺ᏤคΚǹ‫܈‬ӢՈ຀ࢭϿǴόૈΠዎεဉǴဉၰ. 12.

(23) ଳᔴǴठεߡઝ่ǴЪύԃζ‫܄‬ӭԖ਻ᅉǴࡺ௦‫਻੻ڗ‬ᎦՈঋ౛਻ዎ ဉ‫ݤݯޑ‬Ƕ ߡઝ‫ੰޑ‬ӢࢂӭБय़‫ޑ‬ǴѦགൣ዗ϐٕǵϣ໾໯१௃‫ד‬ǵ഍໚਻ Ոό‫ى‬฻ࣣё‫׎‬ԋߡઝǴЪӚᅿচӢΞத࣬ঋࣁੰǴ٬ੰӢፄᚇӭᡂǶ ߡઝ‫ੰޑ‬ՏӧεဉǴ‫س‬εဉ໺ᏤѨதǴՠதᆶ๠ǵगǵ‫ޤ‬ǵ‫ط‬ǵ๝฻ ᠌๜фૈѨፓԖᜢǶЬाϩԋΠӈ൳ᅿ᛾ࠠ 32-34Ǻ 1ǵဉगᑈ዗Ǻનᡏ໚౰Ǵ‫܈‬໯ଚၸӭǴ‫܈‬ၸ१ٌᇺࠆ‫ښ‬Ǵ‫܈‬ᇤܺ ᛰҡԶठ዗ࢥϣ౰ǹ‫܈‬዗ੰϐࡕǴᎩ዗੮ᠰǹ‫ޤ‬ᔿ‫ޤ‬዗Π౽‫ܭ‬ε ဉ֡ёᏤठဉगᑈ዗Ǵ઻໾ࢭనǴаठဉၰଳᔴᔿ่Զ‫׎‬ԋ዗ઝǶ 2ǵ਻ᐒᢠᅉǺኁཆࡘቾၸࡋǹ‫܈‬Φ֤Ͽ୏ǹ‫܈‬ѦࣽЋೌࡕဉၰℚ ೱǹ‫܈‬ຳѺཞ໾Զ໾Ϸဉगǹ‫਻ޤ܈‬όफ़Ǵ֡ёᏤठεဉ਻ᐒᢠ ᅉǴ೯फ़ѨதǴ໺ᏤѨᙍǴᕪಊϣଶԶ‫׎‬ԋ਻ઝǶ 3ǵ਻Ո഍ࢭᖝ຀ǺੰࡕǴౢࡕϷԴԃᡏ১ϐΓǴ਻Ոᖝ຀ǹ‫ੰ܈‬ ύ‫ݯ‬ᕍၸҔԠΠǵճᔸϐᏊǴཞ໾഍ࢭǹ‫܈‬ౢࡕၸࡋǴрԠၸӭ ‫࠻܊܈‬മ॰Ǵཞ໾਻Ո഍ࢭǴ‫܈‬ન஻੃෰Ǵ഍ࢭᖝ઻Ƕ਻຀߾ε ဉ໺ᏤคΚǴ഍Ոᖝ຀߾ဉၰଳᔴ೷ԋ຀ઝǶ 4ǵத१ൣథғհǴ‫܈‬Ҕधൣᛰ‫ނ‬Ǵҵ໾໚਻ǹ‫܈‬ԃԴᡏ১Ǵ੿໚ό‫ى‬Ƕ ๠๝ဉ਻຀১Ǵྕྦค៾ǴόૈᇃϯࢭనǴྕዎဉၰǴ‫ࢂܭ‬഍ൣϣ ่ǴᕪಊόՉǴᏉᑈဉၰԶԋհઝǶ. 13.

(24) ҁࣴ‫ز‬௦Ҕ‫ޑ‬ύᛰБᏊǴ௦ҔȠߎ჆ाౣɡჍӗⱅΠճੰે᛾ ‫ݯ‬ጇȡύ‫ޑ‬ε໳Ғ૛෯ǴЎύ૶ၩǴ Ȩ१ςջӗ‫ޣ‬Ǵε໳Ғ૛෯ЬϐǶȩ 35. ྽ύǴᛰ‫ܺޑނ‬ҔБ‫૶ݤ‬ၩǴ Ȩε໳Ѥ‫ٿ‬ǴҒ૛΋‫ٿ‬ǹ΢Β‫ښ‬Ǵа. НΟϲǴฆ‫ڗ‬΋ϲǴϩྕӆܺǶȩԶᐕжЎ᝘ύǴ‫ܭ‬Ƞဃᔮᕴᒵȡ ύ૶ၩǴЬ‫ݯ‬ȨН໳Ƕय़ҞॿߙǴ‫قئ‬ӰᇟǴᇟᖂόрǶȩᐕжᙴ ৎຑፕǴӵȠᙴ‫ߎے‬᠙ȡֆᖰϓǺ Ȩ१ςջӗ‫ޣ‬ǴОΨǴаൣ‫܄‬ᒨǴ О‫࡚܄‬ॐǴࡺаε໳Ғ૛෯጗ύᘞОǴОѳԾόӗΨǶȩ36Ƞߎ჆ᝌ ှȡ໳‫ڷ‬ၩГǺ Ȩፏ଍ؑ΢Ǵࣣឦ‫ܭ‬ОǴ१ςջӗǴࢂग዗΢ؑǴ଍ Զόૈ৒१ǴᆶगϸൣჍН໯όӕǴࡺҔࢂ෯аѳग዗Ƕȩ Ƞߎ჆၍ ញȡߎტξᇡࣁǺ Ȩ१ςջӗǴᆶ೯தර१ከӗϐϸगԖձǴՠᔈҔ ਔόૈ໻Ꮷ೭΋ᗺǴᗋᔈԖჴ᛾ჴેϐᏵǴ ೯‫ځ‬ग๜Ǵ߾ᐜ਻ΠՉǴ ჍӗёЗǶȩ Ƞߎ჆ጇှȡำߐഓϓǺȨऩ१ςջӗ‫ޣ‬Ǵࢂ໚ܴᑈ዗ ΢ؑǴ‫ە‬ε໳Ғ૛෯аᘞ‫ځ‬዗Ǵ዗р߾ؑЗჍЗǴջ߻፣‫܌‬ᒏ१ς ջӗǴೢϐԖОࢂΨǶȩ Զ‫ܭ‬౜Ϟᖏ‫زࣴ׉‬ύǴε໳Ғ૛෯ቶ‫زࣴޑݱ‬ၮҔӧԖᝄख़⧋Ј Ⴭӗੱ‫ੰޑރ‬஻ 37ǹΨԖᏢ‫ޣ‬ၮҔε໳Ғ૛෯‫ݯܭ‬ᕍλ‫ٽ‬Ⴧ१ੱ 38ǹ ԖൔᏤၮҔε໳Ғ૛෯‫ݯܭ‬ᕍဎ೽Ћೌࡕօ଍ੱ‫ޑރ‬ᕍਏᢀჸᆶຑ՗ 39. ǹҭԖᏢ‫ޣ‬ၮҔ‫ݯܭ‬ᕍႣٛဉၰЋೌࡕ‫ׯ‬๓ဉഞ࿄ᖏ‫׉‬ᕍਏᢀჸ 40Ƕ. ฽‫ޣ‬ᒧҔԜБ଺ࣁᖏ‫׉‬ᕍਏᢀჸǴҭࢂவ೚ӭᖏ‫׉‬ਢ‫ٯ‬ύǴள‫ډ‬ᡍ᛾Ǵ ࢂаୖԵఉӀӹ฻ 41 ளрε໳Ғ૛෯‫ޑ‬ᒣ᛾ाᗺǴᔈࣁ१ςջӗǴᖏ 14.

(25) ‫׉‬όѸ‫ܭܥ‬໚ܴग዗๜ჴǴคፕൣ዗຀ჴǵϣ໾Ѧགǵஎ१࿀໯ǴԖ ࢂ᛾ջҔࢂБǶ Ȩ‫ښ‬धǴ Զε໳ǴΏᖏ‫׉‬΢தҔύᛰǴ Ƞઓၭҁ૛࿶ȡ42-43 ύ૶ၩǺ ൣǶЬΠ྿ՈǵՈഈǵൣ዗Ǵઇ᝛⡴ᑈᆫǴ੮໯எ१ǴᑲᅗဉगǴ௢ ഋठཥǴ೯ճНၰǴፓύϯ१ǴӼ‫ک‬ϖ᠌Ǵғξ‫ك‬Ƕȩ Ƞҁ૛ഢाȡύ ૶ၩǺ ȨεधεൣǴΕ‫ى‬ϼ഍ǴЋ‫ى‬໚ܴǵല഍ՈϩǴ‫ੌ܄ځ‬Զό؇Ǵ ‫ځ‬Ҕ‫و‬ԶόӺǶҔаᑲᅗဉगǴΠᔿ่Զନ྿዗Ƕ‫ݯ‬໾ൣਔ੯Ǵว዗ ខᇟǴྕ዗ᐺᅫǴΠฟ‫ه‬қǴဎภ㚊࡚Ǵ໳੸НဍǴ᝛⡴ᑈᆫǴ੮໯ எ१ǴЈဎฤᅈǴΒߡό೯ǴӗՈἴՈǴՈഈՈ࢏Ǵཞ໾ᑈՈǴ΋Ϫ ჴ዗ǴՈύҷОǶՉНନ࿀Ǵᇑᖋ੃ဍǴૈ௢ഋठཥǶȩ ȠঞǷཥঅҁ ૛ȡύ૶ၩǺ ȨஒैǴ‫ښ‬धǴൣǵεൣǴคࢥǶЬΠ྿ՈǴՈഈǴൣ዗Ǵ ઇ᝛⡴ᑈᆫǴ੮໯எ१ǴᑲᅗဉगǴ௢ഋठཥǴ೯ճНዼǴፓύϯ१Ǵ Ӽ‫ک‬ϖ᠌ǶѳगΠ਻Ǵନ࿀ჴǴဉ໔่዗ǴЈဎ๞ᅈǴζηภǴፏԴ Ո੮่Ƕȩ ౜жε໳‫ޑ‬ᖏ‫زࣴ׉‬ǴୖԵύᙴᛰ‫ہ‬঩཮ၗ਑ 44Ǵε໳ԋϩ֖Ԗ ε໳⇌ (Chrysophanolz)Ǵε໳ન (Rheumemodin)Ǵพᘞ㧿 (Sennoside)ǴషΒ䀝✉ (Heterodianthrone) ε໳⇌㧿(Chrysophanein)Ǵ ‫ځ‬дଛᑗᡏǴ‫ٽ‬ૡᆒ((+)-Catec hin)ǴਦҜㄽؒ१η㧿 (2-O-Cinnamoyl-l,6-di-O-galloyl-͊-D-glucoside)ǴႵ‫ؒ׵‬१η㧿 ( Rhatannin ) ฻Ƕᛰ౛բҔЬाϩࣁаΠ‫ٿ‬ᜪǺ΋ǵᘞΠբҔǺҁࠔ 15.

(26) Н‫܈‬ᎇ‫ނڗܜ‬Ǵჹ‫ܭ‬λқႵ࿶α๏ᛰԖᘞΠբҔ 45-47Ƕ‫ځ‬Н‫ނڗܜ‬ό ቹៜλဉϣᅹ҃ᒡଌբҔǴՠૈߦ຾ᅹ҃௨‫ݧ‬բҔǴόቹៜλဉϣН ϩໆǴૈቚуεဉϣНϩໆ 48Ƕ‫ނڗܜ‬аԼԺ‫܈‬ᓉેϣ‫ݙ‬৔๏ᛰਔǴ ߾όวғᘞΠբҔǶҁࠔᘞΠբҔᆶՈՉคᜢǴΏ‫ޔ‬ௗբҔ‫ܭ‬εဉǴ Їଆεဉၮ୏ϗ຾ǴНϩໆቚуԶౢғᘞΠբҔǶ Βǵफ़եՈύֿન ේբҔǺҁࠔႵ‫ؒ׵‬१η㧿 (rhatannin) ԋϩаဎ๚๏ᛰ‫ݙ‬৔‫ܭ‬ৎ‫ټ‬Ǵ ёफ़եՈύֿનේ (BUN) բҔǴ‫לځ‬๵ࢲ‫܄‬ԋϩࣁε໳ለ (rhein)ǵ ε໳ન (emodin)ǴԶၯᚆࠠϐጳ़ғ‫ނ‬ϐ‫ל‬๵‫܄‬ၨ১ǶΞН‫ނڗܜ‬ҭ Ԗ‫ל‬ᘠၸ‫ࢥੰ܄‬բҔǶ Զӧ౜жε໳‫ޑ‬ᖏ‫׉‬ᔈҔБय़Ǵᖏ‫׉‬΢೚ӭ‫زࣴޑ‬ǴᔈҔӧ‫ݯ‬ᕍ ᄌ‫ߡ܄‬ઝ 49-53ǵೌࡕߡઝǵ‫לځࢂ܈‬གࢉբҔǵճᖌբҔ‫ࢂ܈‬ЗՈբ ҔǴ֡ᕇள‫ؼ‬ӳᕍਏ 49-52, 54-57Ƕ όၸǴε໳‫ޑ‬٬Ҕሡᙣ཈Ǵᖏ‫׉‬΢ൔᏤǴε໳‫ښ܄‬धൣǴΦܺܰ ཞ໾๠गǴၸໆёЇଆ⧋ЈǵჍӗǵᓐܶǵဎ๞ǵဎภǵဎᘞ฻ੱ‫ރ‬Ƕ ‫ځ‬ᗨࢂ೯ߡ‫ؼ‬ᛰǴՠ཮Їଆᝩว‫ߡ܄‬ઝǴ೭ࢂҗ‫ܭ‬ε໳ࡽ֖Ԗ೯εߡ ԋϩȐӵ่ӝ䀝䆉ȑǴӕਔᗋ֖ԖЗᘞԋϩȐӵᚌ፦ȑ Ǵ‫ځ‬λᏊໆܺҔ ࡕԖਔό໻όЇଆᘞΠϸᔈǴЪևԏᔙբҔǴଶᛰࡕջр౜ᝩว‫ߡ܄‬ ઝ 58-59ǶόၸǴ΋ѿวғᝩว‫ߡ܄‬ઝǴѝाቚ१ᑧ१ᠼᆢȐӵӭӞጫ ๼Н݀ȑ‫܈‬ӭ໯Нǵӭࡪነဎ೽ǵቚуၮ୏ໆϷፓ᏾Ј౛‫ރ‬ᄊǴࡌҥ. 16.

(27) ҅த௨ߡϸ৔Ǵߡё੃ନǶߏය٩ᒘε໳ᘞΠբҔٰ௨ࢥǴᗋૈቹៜ Γᡏჹࢌ٤Ԗ੻‫ނ‬፦‫֎ޑ‬ԏǴ೷ԋ೦Ո‫ޑ‬ό‫ ݀ࡕؼ‬60Ƕ Ғ૛‫ࢂ׳‬ᖏ‫׉‬΢தҔύᛰǴ Ƞઓၭҁ૛࿶ȡ61-62 ύ૶ၩǺȨ‫ښ‬ҒǴ ѳǶЬϖ᠌Ϥ๜ൣ዗ٕ਻Ǵ୲โମǴߏԼԺǴ७ΚǴߎബ ǴှࢥǶΦ ܺǴᇸ‫ي‬ǵ‫ۯ‬ԃǶȩȠҁ૛ഢाȡύ૶ၩǺȨԖံԖᘞǴૈ߄ૈ္Ǵё ϲёफ़‫ښ‬ҒǶғҔ਻ѳǴံ๠गό‫ى‬ԶᘞЈОǶ‫ݼ‬Ҕ਻ྕǴံΟขϡ ਻Զණ߄ൣǶΕ‫ک‬Ꮚ߾ံ੻ǴΕԠᏊ߾ှԼǴΕథᏊ߾ᘞٕ዗ǴΕ৚ Ꮚ߾጗҅਻ǴΕዎᏊ߾Ꭶ഍ՈǶૈ‫کڐ‬ፏᛰǴ٬ϐό‫ݾ‬ǶғԼЗภǴ ೯ՉΜΒ࿶ǴှԭᛰࢥǴࡺԖ୯ԴϐᆀǶȩ ȠঞǷཥঅҁ૛ȡύ૶ၩǺ Ȩ‫ښ‬ҒǴѳǴคࢥǶЬϖ᠌Ϥ๜ൣ዗ٕ਻Ǵ୲โମǴߏԼԺǴ७ΚǴ ߎየဍǴှࢥǴྕύΠ਻Ǵྠᅈอ਻Ǵ໾᠌ࠏ჌ǴЗ෰Ǵ೯࿶ેǴճ Ո਻ǴှԭᛰࢥǴࣁΐβϐᆒǴӼ‫ک‬ΎΜΒᅿҡǴ΋ίΒԭᅿ૛ǶΦ ܺᇸ‫ۯي‬ԃǶȩ Ƞҁ࿶౧᛾ȡϓǺ ȬȠ໾ൣፕȡ ǵ Ƞߎ჆ाౣȡ‫ٿ‬ਜύǴΥ ࣁБΒԭϖΜǴҔҒ૛‫ޣ‬ǴԿԭΒΜБǶߚҒ૛ϐЬੰӭǴΏፏБѸ ӝҒ૛Ǵ‫ૈۈ‬Ԕ྽ੰ௃ΨǶΥᛰϐණ‫ޣ‬ǴѦԶόϣǹ‫ޣװ‬ǴΠԶό΢ǹ ྕ‫ޣ‬ǴᔿԶόᔶǹమ‫ޣ‬Ǵ‫ڃ‬Զό‫ک‬ǹᚇ‫ޣ‬Ǵ౲ԶόဂǾǾऩคҒ૛ፓ Ꮚය໔Ǵၱ‫ځ‬۳Զό߇ǴаࣁՉᓀႸॴϐीǴό౦‫ܭ‬ઇଠ؈ՃǴёയ ԶόёόയǴ␢၈،യϐၰओǻȭ ౜жҒ૛‫ޑ‬ᖏ‫زࣴ׉‬ǴୖԵύᙴᛰ‫ہ‬঩཮ၗ਑ 63ǴҒ૛‫ޑ‬ਥ‫ک‬ਥ ಳ֖Ο亻‫ج‬㧿Ғ૛ለ (Glycyrrhizic acid)ǴջҒ૛ౡન (Glycyrrhizin)Ǵ 17.

(28) ࢂҒ૛ԛለ (Glycyrrhetinic acid) ‫ޑ‬Βဟ๻ᑗ⾺ለ㧿ǴࣁҒ૛‫ޑ‬ౡ‫ښ‬ԋ ϩǶᛰ౛բҔЬाϩࣁаΠ൳ᜪǺ‫ک‬ύ጗࡚Ǵዎ‫ޤ‬ǴှࢥǴፓ‫ک‬ፏᛰǶ 1ǵ‫ݼ‬ҔǴ‫ݯ‬๠ग຀১Ǵ१ϿǴဎภߡ▋Ǵമ॰ว዗Ǵ‫ޤ‬࿅ࠏ჌ǴЈௌǴ ᡋ⻯ǹ2ǵғҔǴ‫ࠒݯ‬ോဍภǴ੃ϯ‫܄‬ውᅬǴ㕢ੴየᅬǴှᛰࢥϷ१‫ނ‬ ύࢥǶ Զӧ౜жҒ૛‫ޑ‬ᖏ‫׉‬ᔈҔБय़Ǵᖏ‫׉‬΢೚ӭ‫ زࣴޑ‬64-65Ǵ᛾ჴҒ ૛ለࢂҒ૛ύ‫ޑ‬Ьाࢲ‫܄‬ԋϩǴ‫ڀ‬Ԗᡉ๱‫ޑ‬ᜪ๝΢ဏҜ፦ᐟનբҔǴ ёҔ‫ܭ‬Γᡏ‫ל‬૰Դǵ‫ݹל‬ǵफ़ᓸǵቚமᐒᡏխࣝΚǵගଯғ౛ᐒૈǵ ‫ڋ׭‬ᕎಒझғߏ฻Ǵᖏ‫׉‬΢‫ޑ‬ᔈҔ߄ܴΑ‫ځ‬ዴჴ‫ޑ‬ᕍਏ 66Ƕ Ғ૛ᛰ‫܄‬ᗨѳǴᖏ‫׉‬Ψᔈ‫ݙ‬ཀଛҴ࿣‫ג‬ǶȸΜΖϸᄺȹύȸǾᝯ ඐၱ᭪ॿᏯ૛Ǿȹόёό‫ ޕ‬67Ƕᙴৎ৪Ᲊྛ 68-69 Ԗ‫ق‬ǺȸᇤҔठ্Ǵ ᗨҒ૛ǵΓୖҭࢥᛰϐᜪΨǶȹࡺᖏ‫׉‬ᇾБҔᛰᔈుࡘዕቾǶ ࢂаǴҒ૛‫ޣ‬ǴᛰΨǶΥᛰѸԖᛰ‫܄‬Ǵࣁᙴ‫ޣ‬྽аᛰ‫܄‬Զࡼϐᖏ ‫׉‬ǴჴΏࣁᙴ‫ޣ‬ϐၰΨǶ. ಃϖ࿯. Ӽჱੰ‫܊‬ᕎ҃ੰ஻ߡઝϷဉगੱ‫ޑރ‬ຑ՗π‫ڀ‬. ҁࣴ‫ز‬ीฝ‫ޑ‬ਏ੻ (outcome measure) ‫ޑ‬ຑ՗໨Ҟх֖Ǻ ΋ǵȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱. 18.

(29) ਥᏵΖΜΐԃΎДϦթჴՉ‫ޑ‬ȬӼჱᕍៈ᏾ӝ‫ྣ܄‬ៈયΕӄ଼҇ நߥᓀ๏б၂ᒤीฝȭύ‫ࠔޑ‬፦ᅱ௓ࡰ኱Ǵࡰ኱྽ύӅϩ‫ٿ‬εቫय़Ȑߕ ᒵ 1ȑ Ǻ 1ǵ่ᄬࡰ኱ǺԖᜢȨ่ᄬय़ȩϐ೛‫ۓ‬Ǵமፓ‫ࢂޑ‬ග‫ٮ‬Ӽჱᕍៈ‫܌‬ Ѹሡ٩ᒘ‫ޑ‬ᐒᄬᕉნǵಔᙃǵ೛ࡼǵၮբБԄϷၗྍǾ฻Ǵ٠ୖ ԵӼჱᕍៈՐଣǵۚৎᕍៈೕጄ኱ྗǴ֖ࡴ‫ځ‬ύ‫ޑ‬໨Ҟӵ‫׫‬ΕӼ ჱᕍៈ‫ޑ‬ი໗ΓΚ‫ݩރ‬ǵი໗Γ঩ၗ਱ᆶ૽ግǴӵፁғ࿿ߥ଼ೀ ‫܌‬ᔕϐȨՐଣӼჱᕍៈ೛࿼୷ྗȩǶ 2ǵၸำࡰ኱ǺȨၸำय़ȩ๱ख़‫ࢂޑ‬ග‫ٮ‬ӼჱᕍៈਔǴวғ‫ੰܭ‬Γ Ϸი໗Γ঩໔‫ޑ‬ᕍៈࢲ୏Ƕ Ӛ໨ຑϩ኱ྗ֡வ 0 ϩ‫ ډ‬4 ϩǴϩኧຫଯж߄၀໨ࡰ኱ำࡋᖿ ӛᝄख़Ƕ ‫ॺך‬ᘏ‫ࡰڗ‬኱ύᆶဉगੱ‫࣬ރ‬ᜢ‫ޑ‬ຑϩᅱ௓ࡰ኱຾Չԏਢ‫ޣ‬ຑϩ Ȑߕᒵ 2ȑ Ǵх֖ߡઝ‫ࡰݩރ‬኱ǵ१ኅ‫ࡰݩރ‬኱ǵဎ๞‫ࡰݩރ‬኱Ϸ⧋Ј Ⴭӗ‫ࡰݩރ‬኱Ƕ Βǵᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ (EORTC QLQ-C30 V3.0) EORTC QLQ-C30 ࢂኻࢪᕎੱࣴ‫ݯز‬ᕍಔᙃ (European Organization for Research and Treatment of Cancer, EORTC) ‫س‬಍Ӧ໒ ว‫ޑ‬ᕎੱੰ஻ғ‫ࠔڮ‬፦ෳ‫ۓ‬ໆ߄ᡏ‫س‬ύ‫ޑ‬ਡЈໆ߄ǴҔ‫܌ܭ‬Ԗᕎੱੰ. 19.

(30) ஻‫ޑ‬ғ‫ࠔڮ‬፦ෳ‫ۓ‬Ȑෳ‫ځۓ‬Ӆ‫܄‬೽ϩȑ ǴӧԜ୷ᘵ΢ቚуόӕᕎੱ‫ޑ‬੝ ౦‫܄‬చҞȐኳಔȑջᄬԋόӕᕎੱ‫ޑ‬੝౦ໆ߄Ƕ1999 ԃ௢рΑ‫ځ‬ಃΟ ‫ހ‬ҁǶ᠙‫ ܭ‬QLQ-C30 (V3.0) ቶ‫ޑݱ‬୯ሞቹៜ‫ک‬ჴҔ‫܄‬Ǵύ୯εഌᏢ ‫ޣ‬Ԗࣴ‫ز‬Ǵ‫ ܭ‬1997 ԃ໒‫ࣴۈ‬ᇙ‫ ځ‬V 2.0 ύЎ‫ހ‬ǴᒿࡕΞࣴᇙ V 3.0 ύЎ‫ހ‬Ǵ௦Ҕໆ߄‫ޑ‬ᅇϯБ‫ݤ‬ǴEORTC ග‫ޑٮ‬मЎ‫ހ‬ໆ߄‫ޔ‬ௗ຾Չ ᅇϯ‫׎‬ԋ҅Ԅ‫ޑ‬ύЎ‫ހ‬ໆ߄Ƕ ԶӧȬӄ଼҇நߥᓀဍዦੰ஻Ћೌǵϯᕍǵ‫ܫ‬৔ጕᕍ‫ࡕݤ‬ՋᙴՐ ଣੰ஻ύᙴᇶշᙴᕍ၂ᒤीฝȭύǴҭբࣁ‫ݯ‬ᕍᅱෳ໨Ҟϐ΋Ƕ EORTC ‫ ޑ‬QLQ-C30 (V 3.0) ࢂଞჹ‫܌‬Ԗᕎੱੰ஻‫ޑ‬ਡЈໆ߄ Ȑߕᒵ 3ȑ ǴӅ 30. ঁຑϩ໨ҞǶ‫ځ‬ύǴ໨Ҟ 29ǵ30 ϩࣁΎঁ฻ભǴ. ਥᏵ‫ځ‬ӣเᒧ໨Ǵीࣁ 1 ϩ‫ ډ‬7 ϩǹ‫ځ‬дచҞϩࣁ 4 ঁ฻ભǺவؒ ԖǵԖ΋ᗺǵၨӭԿࡐӭǴຑϩਔǴ‫ޔ‬ௗຑ 1 ‫ ډ‬4 ϩǶ ‫܌‬аǴEORTC QLQ-C30 ύЎ‫ڀހ‬Ԗၨӳ‫ࡋߞޑ‬ǵਏࡋϷϸᔈࡋǴ Ҕ‫ܭ‬ᕎੱੰ஻‫ޑ‬ғ‫ࠔڮ‬፦ෳ‫ۓ‬Ƕ೯ၸჹൾ‫܄‬ဍዦੰ஻ғ‫ࠔڮ‬፦‫ޑ‬ෳ ໆǴ٬ᙴৣ‫ܭ‬ᖏ‫׉‬΢ᒧ᏷‫׳‬ӳ‫ݯޑ‬ᕍБ‫ݤ‬Ϸჹ҃යᕎੱੰ஻௦‫ڗ‬ଞჹ ‫܄‬ᆅ౛ჹ฼Ƕ. 20.

(31) Οǵғࢲࠔ፦ຑ՗߄ (ECOGǺEastern Cooperative Oncology Group Performance Status) ECOG фૈ‫ރ‬ᄊຑϩ߄Ȑߕᒵ 4ȑ Ǵ‫ܭ‬ҁࣴ‫ز‬ύЬा٩ྣੰ஻྽ਔ ‫يޑ‬ᡏфૈ‫ރ‬ᄊǴуаຑϩǶ ҁໆ߄௦Ҕ٥ࢪᖄӝဍዦ‫ ཮ڐ‬Eastern Cooperative Oncology Group(1960) ‫܌‬ว৖ϐ ECOG Performance Status ຑໆੰ஻‫ي‬ᡏфૈ ‫ރ‬ᄊǴໆ߄ϩԋϖঁ฻ભ (0ɴ4)ǴભኧຫଯǴ߄Ң‫ي‬ᡏфૈ‫ރ‬ᄊຫৡǴ 0 ભ߄Ңёֹӄ҅த‫୏ࢲޑ‬Ǵૈ୺Չғੰ߻ϐ‫܌‬ԖфૈԶคҺՖ‫ڙ‬ ज़ǹ1 ભ߄Ң‫ي‬ᡏᗨԖό፾‫ޑ‬᝛‫ރ‬Ǵՠόሡޮ‫׉‬ǴқϺπբ҅தǴՠ ၨ຤Κ‫ڙ୏ࢲޑ‬ज़‫ڋ‬ǹ2 ભ߄Ң΋Ϻ྽ύ 50% аΠ‫ޑ‬ਔ໔ሡज़‫ڋ‬ӧ ‫׉‬΢‫܈‬ශη΢ǴВதғࢲёֹӄԾ‫៝ྣך‬Ǵՠค‫୺ݤ‬ՉҺՖ‫ޑ‬πբǹ3 ભ߄Ң΋Ϻ྽ύຬၸ 50% а΢‫ޑ‬ਔ໔ሡज़‫ڋ‬ӧ‫׉‬΢‫܈‬ශη΢Ǵ໻ё ֹԋ೽ҽ‫ޑ܄‬Вதғࢲྣ៝ǹ4 ભ߄Ң 100% ਔ໔ޮ‫׉‬Ǵค‫ֹݤ‬ԋВ தғࢲԾ‫៝ྣך‬ǶԜໆ߄‫ܭ‬ᖏ‫׉‬΢ςቶ‫ݱ‬Ҕ‫ܭ‬ຑ՗ᕎੱੰ஻྽ਔ‫ޑ‬ф ૈ‫ރ܄‬ᄊǶ. 21.

(32) ಃΟക ‫׷‬਑ᆶБ‫ݤ‬ ಃ΋࿯. ኬҁᒧ‫ڗ‬ᆶϩಔ. ΋ǵʳ၂ᡍ೛ीȐ߄ 3.1ȑ 1ǵ಄ӝયΕచҹǴ٠‫؂‬Տ‫ڙ‬၂‫ڙ܈ޣ‬၂‫ޣ‬ৎឦֹ֡ӄᕕှҁࣴ ‫ز‬ीჄϣ৒Ǵ٠ӕཀуΕǴջࣁԏਢჹຝǶҁࣴ‫ز‬٩Ԗค๏ϒ ε໳Ғ૛෯ᛰనϩࣁჴᡍಔᆶჹྣಔǴ௦ᒿᐒϩଛ຾ՉǴ٠а ൂ‫ޓ‬ᖏ‫׉‬၂ᡍ຾ՉǶ z ჴᡍಔǺ๏ϒε໳Ғ૛෯ᛰనȐᏊໆ/ܺҔ໔႖ਔ໔Ǵ‫ܭ‬ಃѤ ࿯ᖏ‫׉‬ჴᡍБ‫ݤ‬Ϸࢬำύᇥܴȑ ǴЪᆢ࡭চԖ‫ޑ‬ՋᙴྣៈǶ z ჹྣಔǺࣁᆢ࡭চԖ‫ޑ‬ՋᙴྣៈǶ 2ǵҁࣴ‫ز‬ჴᡍ೛ी௦Ҕᒿᐒ௓‫( ڋ‬Randomized controlled trialǴ RCT) БԄǴࣴ‫ز‬Γ঩ஒ‫ڙ‬၂‫ޣ‬٩໩‫ࡌׇ‬ҥ୷ҁၗ਑ӜнǴӆа ႝတᒿᐒϩଛԿΒಔǶ ΒǵʳયΕచҹ 1Ε Ӽჱੰ‫܊‬ᕎ҃Րଣੰ஻Ƕ 2Ε ੰ஻‫ڀ‬Ԗߡઝੱ‫ރ‬Ǵ࿶ȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱ ໆ߄ຑ՗Ǵߡઝϩኧ!ɪ2 ϩ‫ޣ‬Ƕ 3Ε ‫ت‬ζό‫ܥ‬Ǵԃស໪‫ ܭ‬20-80 ྃǶ 4Ε คᑗֿੰੰўǶ 22.

(33) Οǵʳ௨ନచҹ 1Ε ς࿶຾Εᖏಖྣៈ໘ࢤੰ஻Ƕ 2Ε ੰ஻࿶ȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱ໆ߄ຑ՗Ǵߡઝ ϩኧ <2 ϩ‫ޣ‬Ƕ 3Ε ҅ௗ‫ڙ‬ଣϣǵѦ‫ځ‬дύᛰ‫ޣ‬Ƕ 4Ε ऩԏਢੰ஻‫ݯܭ‬ᕍύวғੱ‫ރ‬уቃǴӵቚу⧋ЈǵჍӗ௃ ‫׎‬Ǵ߾໪ଏрҁࣴ‫ز‬ीฝǶ 5Ε ऩԏਢੰ஻‫ݯܭ‬ᕍύวғ௃ᆣ΢௨ѾǴ‫ੰ܈‬஻ৎឦόᜫ࡭ុ ଛӝǴ߾໪ଏрҁࣴ‫ز‬ीฝǶ ಃΒ࿯. ᖏ‫׉‬၂ᡍ൑‫܌‬. ҁࣴ‫ܭز‬ᄆϯ୷࿎௲ᙴଣύ๮ଣ୔Ӽჱੰ‫܊‬຾ՉǶ ಃΟ࿯. ᖏ‫׉‬၂ᡍҔᛰϷϟಏ. ΋ǵʳε໳ȐᐚᕭࣽᏢύᛰǴ໩Ϻ୸ᛰቷᇙ೷Ǵ‫ץ‬ဦ 276001Ǵӵკ 3.1ȑ ୷ྍǺ⬮ࣽ෌‫ނ‬ঞђ੝ε໳ Rheum tanguticum Maxim. ex Balf. ౢӦǺѤο. 23.

(34) ࣁΑዴᇡύᛰ‫׷‬࿶๧‫ڗ‬ᐚᕭࡕǴ‫ځ‬ԖਏԋϩϷӼ‫܄ۓ‬Ǵ໩Ϻ୸ᛰቷ а ଯਏన࣬ϩ‫݋‬ሺ (HPLC)Ǵ຾Չϩ‫݋‬Ȑӵკ 3.2ȑዴ‫ځۓ‬ԖਏԋϩϷ Ӽ‫܄ۓ‬Ƕ ߄ 3.1ǵᖏ‫׉‬၂ᡍࢬำ. ᕴԏਢΓኧ. Nɨ 30. ؒԖୖᆶཀᜫ‫܈‬಄ӝ௨ନచҹ Nɨ3 ᒿᐒϩଛԿ‫ݯ‬ᕍಔᆶჹྣಔ! NЈ27. ჴᡍಔ ௗ‫ ڙ‬6 Ϻε໳Ғ૛෯‫ݯ‬ᕍ ӝ‫ٳ‬ՋᙴӼჱྣៈ‫ݯ‬ᕍ Nɨ12. ჹྣಔ ࡭ុՋᙴӼჱྣៈ‫ݯ‬ᕍ Nɨ15. ԏ໣ੰ஻ໆ߄ၗ਑຾Չ಍ीϩ‫!݋‬. 24.

(35) კ 3.1ǵε໳ࣽᏢύᛰკ. კ 3.2ǵε໳ HPLC კ. 25.

(36) ΒǵʳҒ૛ȐᐚᕭࣽᏢύᛰǴ໩Ϻ୸ᛰቷᇙ೷Ǵ‫ץ‬ဦ 185645Ǵӵკ 3.3ȑ ୷ྍǺ‫ࣽل‬෌‫ނ‬Ғ૛ Glycyrrhiza uralensis Fisch. ౢӦǺϣᆾ ࣁΑዴᇡύᛰ‫׷‬࿶๧‫ڗ‬ᐚᕭࡕǴ‫ځ‬ԖਏԋϩϷӼ‫܄ۓ‬Ǵ໩Ϻ୸ᛰቷ а ଯਏన࣬ϩ‫݋‬ሺ (HPLC)Ǵ຾Չϩ‫݋‬Ȑӵკ 3.4ȑዴ‫ځۓ‬ԖਏԋϩϷ Ӽ‫܄ۓ‬Ƕ. კ 3.3ǵҒ૛ࣽᏢύᛰკ. კ 3.4ǵҒ૛ HPLC კ. 26.

(37) ಃѤ࿯. ᖏ‫׉‬ჴᡍБ‫ݤ‬Ϸࢬำ. ΋ǵʳჴᡍಔ‫ݯ‬ᕍ‫؁‬ᡯ 1Ε ஒ 2 լख़ε໳ᐚᕭࣽᏢύᛰǴᆶ 0.5 լख़Ғ૛ᐚᕭࣽᏢύ ᛰǴϩԋѤ฻ϩǶ 2Ε ‫؂‬ВΟᓓ໭ࡕϷᅵ߻ӅѤԛܺҔǴᙖҗαܺǵሷगᆅ‫܈‬࿶җ ग೷䈜α‫܈‬ဉ೷䈜α๏ᛰǶ 3Ε ੰ஻‫ܭ‬๏ᛰ߻຾Չ१ኅຑ՗߻ෳǹ‫ܭ‬ಃ 3 Ϻբ΋ԛ१ኅຑ ՗යύෳໆǶ֡௦Ҕᘏ‫ڗ‬ȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱ໆ ߄ύᆶဉगੱ‫࣬ރ‬ᜢ‫ޑ‬ຑϩᅱ௓ࡰ኱຾Չԏਢ‫ޣ‬ຑϩȐߕᒵ 2ȑ Ƕ 4Ε ‫ڙ‬၂‫ޣ‬ϐύᛰᛰ‫ނ‬ϟΕය໔а 6 Ϻࣁ΋‫ݯ‬ᕍਔ໔Ǵಃ 6 Ϻ ຾Չ१ኅຑ՗ࡕෳǶ 5Ε ‫؂‬Տ‫ڙ‬၂‫֡ޣ‬ϝᆢ࡭΋૓ՋᙴӼჱ‫ݯ‬ᕍ኱ྗำ‫ׇ‬຾ՉǶ Βǵʳჹྣಔ‫ݯ‬ᕍ‫؁‬ᡯ 1Ε ࡪ΋૓ՋᙴӼჱ‫ݯ‬ᕍ኱ྗำ‫ׇ‬຾ՉǶ 2Ε ੰ஻‫ܭ‬ϟΕ߻຾Չ१ኅຑ՗߻ෳǹ‫ܭ‬ಃ 3 Ϻբ΋ԛ१ኅຑ ՗යύෳໆǶ֡௦Ҕᘏ‫ڗ‬ȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱ໆ ߄ύᆶဉगੱ‫࣬ރ‬ᜢ‫ޑ‬ຑϩᅱ௓ࡰ኱຾Չԏਢ‫ޣ‬ຑϩȐߕᒵ 2ȑ Ƕ 3Ε ‫ڙ‬၂‫ޣ‬ϐύᛰᛰ‫ނ‬ϟΕය໔а 6 Ϻࣁ΋‫ݯ‬ᕍਔ໔Ǵಃ 6 Ϻ ຾Չ१ኅຑ՗ࡕෳǶ 27.

(38) Οǵʳຑ՗ 1Ε ϩձ‫ݯܭ‬ᕍ߻Ϸ‫ݯ‬ᕍύ‫ޑ‬ಃΟϺ຾Չ१ኅόਁຑ՗ǶȐऩੰ ஻໻ֹԋΟϺа΢ЪόᅈϤϺᕍำ‫ޣ‬ȑǶ 2Ε ϩձ‫ݯܭ‬ᕍ߻ǵ‫ݯ‬ᕍύ‫ޑ‬ಃΟϺϷಃϤϺǴ຾Չ१ኅόਁຑ ՗߻ǵύǵࡕෳȐऩੰ஻ёаֹԋֹ᏾ϤϺᕍำ‫ޣ‬ȑǶ 3Ε ϩձ‫ݯܭ‬ᕍ߻ǵ‫ݯ‬ᕍ‫ޑ‬ಃϤϺǴ຾Չᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ ໆ߄ (EORTC QLQ-C30 V3.0) Ϸғࢲࠔ፦ຑ՗߄ (ECOGǺ Eastern Cooperative Oncology Group Performance Status) ෳໆǶ. ಃϖ࿯. ᖏ‫׉‬၂ᡍၗ਑ϩ‫݋‬಍ी 1ǵ ࣴ‫่݀ز‬ஒ௦Ҕ SPSS 17.0 ‫ހ‬ҁ಍ी೬ᡏǴ٬Ҕ mixed model ٰ຾Չ่݀಍ीϩ‫݋‬Ƕ. 28.

(39) ಃѤക ่݀ ಃ΋࿯. ‫ڙ‬၂‫୷ޣ‬ҁၗ਑. 2010 ԃ 1 Д 1 ВԿ 2010 ԃ 12 Д 31 Вࣴ‫ز‬ය໔Ӆ 30 Ӝ ੰ஻Ǵ྽ύᔈคཀᜫ‫܈‬಄ӝ௨ନచҹ‫ޣ‬ӅΟΓǶ‫ځ‬Ꭹ‫ڙ‬၂‫ޣ‬аᒿᐒϩ ଛБԄϩଛǶ‫ځ‬ύჴᡍಔ 12 ΓǴѳ֡ԃសࣁ 53.68±3.36 ྃǴჹྣ ಔ 15 ΓǴѳ֡ԃសࣁ 59.68±4.56 ྃǴ‫ځ‬ᎩӚಔϐ‫܄‬ձǵԃសǵ௲ ‫ػ‬ำࡋǵ‫ے‬௲฻Ӛ໨୷ҁၗ਑‫ܭ‬Π߄Ȑ߄ 4.1ȑ ǴճҔ One-Way ANOVA ϩ‫ٿ݋‬ಔϐ୷ҁၗ਑ჹ१ኅόਁӚ໨ຑ՗คৡ౦‫܄‬ǴӢԜǴ‫ٿ‬ಔ‫ڀ‬К ၨ‫܄‬Ƕ ಃΒ࿯ ‫ڙ‬၂‫ޣ‬ϐ٬ҔՋᛰ೬ߡᏊϷЗภᏊ่݀ϩ‫݋‬ ΋ǵ೬ߡᏊ٬Ҕ௃‫׎‬ җΠკள‫ޕ‬Ǵӧᖏ‫׉‬၂ᡍၸำύǴჴᡍಔ‫ڙ‬၂‫ޣ‬Ӆ 12 Ӝੰ஻Ǵ‫ځ‬ ύ΋Ӝੰ஻٬ҔΓπ‫ߐع‬Ǵ‫ځ‬Ꭹа҂ܺҔ೬ߡᏊэӭኧ Ȑ75ʘǴ9 ΓȑǴ Զჹྣಔ‫ڙ‬၂‫ޣ‬Ӆ 15 Ӝੰ஻ǴаԖܺҔ೬ߡᏊэӭኧ Ȑ93ʘǴ14 Γȑ Ȑკ 4.1ǵ4.2 ‫ ک‬4.5ȑǶ. 29.

(40) ߄ 4.1ǵ‫ڙ‬၂‫୷ޣ‬ҁၗ਑. ᡂ໨ ‫ت‬/ζ ԃស Ȑྃȑ ѳ֡ॶ±኱ྗৡ ጄൎ ௲‫ػ‬ำࡋ ό᛽ӷ ୯λ ୯ύ ଯύ εᏢ ‫ے‬௲ ค ၰ௲ Օ௲ ሷगᆅ٬Ҕ Ԗ ค ೬ߡᏊ٬Ҕ Ԗ ค ЗภᏊ٬Ҕ Ԗ ค. ჴᡍಔȐnɨ12ȑ M±SD n 7/5. ჹྣಔȐnɨ15ȑ M±SD n 10 / 5. 53.68±3.36. 59.68±4.56. 38-71. 28-90. 3 5 4 0 0. 5 4 5 0 1. 6 4 2. 8 5 2. 6 6. 8 7. !. 2 10. 14 1. 7 5. 5 10. 30. !.

(41) ΒǵЗภᏊ٬Ҕ௃‫׎‬ җΠკள‫ޕ‬Ǵӧᖏ‫׉‬၂ᡍၸำύǴჴᡍಔ‫ڙ‬၂‫ޣ‬аܺҔЗภᏊэӭ ኧ Ȑ58ʘǴ8 Γȑ ǴԶჹྣಔ‫ڙ‬၂‫߾ޣ‬аԖܺҔЗภᏊэӭኧ Ȑ67ʘǴ 10 Γȑ Ȑკ 4.3ǵ4.4 ‫ ک‬4.5ȑǶ. კ 4.1ǵჴᡍಔϐ೬ߡᏊ٬Ҕ௃‫׎‬. 31.

(42) კ 4.2ǵჹྣಔϐ೬ߡᏊ٬Ҕ௃‫׎‬. კ 4.3ǵჴᡍಔϐЗภᏊ٬Ҕ௃‫׎‬. 32.

(43) კ 4.4ǵჹྣಔϐЗภᏊ٬Ҕ௃‫׎‬. 16 14 12. Γኧ. 10 ЗภᏊ. 8. ೬ߡᏊ. 6 4 2 0. ჴᡍಔ. ჹྣಔ. ЗภᏊ. 8. 6. ೬ߡᏊ. 3. 25. კ 4.5ǵ٬Ҕ೬ߡᏊϷЗภᏊ่݀ኧᏵߏచკ. 33.

(44) ಃΟ࿯. ȬӼჱྣៈࠔ፦ᅱ௓ࡰ኱ȭϐӚ໨ୖኧၗ਑ϩ‫݋‬. аషӝኳԄ (Mix model) ಍ीБ‫ݤ‬ϩ‫ٿ݋‬ಔϐ໔Ϸಔϣ‫ܭ‬όӕਔ ໔຾Չख़ፄෳໆǴ‫ځ‬ϩ‫่݀݋‬ว౜ӧ‫ٿ‬ಔϐ໔ճҔε໳Ғ૛෯‫ݯ‬ᕍᕎ҃ ੰ஻ϐߡઝǵ१ኅόਁϷဎ๞ੱ‫ރ‬ၲᡉ๱ৡ౦‫( ܄‬p<0.05)Ȑ߄ 4.2ȑ ǴԶ ӧ⧋ЈჍӗੱ‫ރ‬΢߾҂ၲᡉ๱ৡ౦‫܄‬ǹаಔϣ຾Չϩ‫݋‬КၨǴ⧋ЈჍ ӗǵ१ኅόਁǵဎ๞Ϸߡઝ௃‫ࣣ׎‬คᡉ๱ৡ౦‫܄‬Ƕ ᕎ҃ੰ஻ёૈӢҁ‫ي‬ค‫҅ݤ‬த຾१‫ࢂ܈‬१ኅό٫฻ቹៜᔼᎦឪ‫ڗ‬ᜢ ߯Ǵ‫ܭ‬Ջᙴᙴᕍೀ࿼཮ක΢ሷगᆅᆢ࡭҅த໯१Ǵࡺҁࣴ‫ز‬௨ନ‫ٿ‬ಔԖ ࿼Εሷगᆅੰ஻ǴӆԛаషӝኳԄ຾Չϩ‫݋‬КၨȐ߄ 4.3ȑ Ǵ่݀ᡉҢ‫ٿ‬ ಔϐߡઝǵ१ኅόਁϷဎ๞ (p<0.05) ࣣၲᡉ๱ৡ౦‫܄‬ǴԶӧ⧋ЈჍӗ ੱ‫ރ‬΢߾คᡉ๱ৡ౦‫( ܄‬p>0.05)ǴԜ่݀ᆶ҂௨ନሷगᆅ௃‫܌׎‬ள‫ޑډ‬ ่݀࣬ӕǶҗԜё‫ޕ‬Ǵሷगᆅ‫ޑ‬Ԗคό཮ቹៜࣴ‫่݀ز‬Ƕ კ 4.6ǵ4.7 ࣁ‫ٿ‬ಔϐߡઝϩኧ่݀ϩ‫݋‬Ǵჴᡍಔ߻ෳѳ֡ϩኧࣁ 2.17±0.22Ǵύෳѳ֡ϩኧࣁ 1.29±0.22Ǵࡕෳѳ֡ϩኧࣁ 1±0.24Ǵ‫ׯ‬๓ ำࡋࣁ 53.91ʘǹჹྣಔ߻ෳѳ֡ϩኧࣁ 1.67±0.26Ǵύෳѳ֡ϩኧࣁ 1.67±0.25Ǵࡕෳѳ֡ϩኧࣁ 1.77±0.28Ǵ‫ׯ‬๓ำࡋࣁ -5.99ʘǹკ 4.8ǵ 4.9 ࣁ‫ٿ‬ಔϐ१ኅόਁϩኧ่݀ϩ‫݋‬Ǵჴᡍಔ߻ෳѳ֡ϩኧࣁ 1.92±0.34Ǵύෳѳ֡ϩኧࣁ 1.13±0.28Ǵࡕෳѳ֡ϩኧࣁ 0.75±0.23Ǵ‫ׯ‬ ๓ำࡋࣁ 60.93ʘǹჹྣಔ߻ෳѳ֡ϩኧࣁ 1.5±0.29Ǵύෳѳ֡ϩኧࣁ 34.

(45) 1.53±0.32Ǵࡕෳѳ֡ϩኧࣁ 1.58±0.353Ǵ‫ׯ‬๓ำࡋࣁ-5.33ʘǹკ 4.10ǵ 4.11 ࣁ‫ٿ‬ಔϐဎ๞ϩኧ่݀ϩ‫݋‬Ǵჴᡍಔ߻ෳѳ֡ϩ ኧࣁ 2.33±0.22Ǵύෳѳ֡ϩኧࣁ 1.71±0.23Ǵࡕෳѳ֡ϩኧࣁ 1.08±0.28Ǵ‫ׯ‬๓ำࡋࣁ 53.64ʘǹჹྣಔ߻ෳѳ֡ϩኧࣁ 1.5±0.263Ǵύ ෳѳ֡ϩኧࣁ 1.73±0.21Ǵࡕෳѳ֡ϩኧࣁ 1.85±0.25Ǵ‫ׯ‬๓ำࡋࣁ -23.33ʘǶ. ߄ 4.2ǵဉगੱ‫ރ‬ໆ߄Ӛ໨ୖኧϩ‫݋‬Ȑ҂௨ନሷगᆅȑ ᡂ໨. ჴᡍಔ M±SD. ჹྣಔ M±SD. ಔ໔ F. P. ߡઝ. ߻ෳ ύෳ ࡕෳ. 2.17±0.22 1.67±0.26 4.746 1.29±0.22 1.67±0.25 1±0.24 1.77±0.28. ɀ. 0.013. १ኅόਁ. ߻ෳ ύෳ ࡕෳ. 1.92±0.34 1.5±0.29 4.424 1.13±0.28 1.53±0.32 0.75±0.23 1.58±0.35. ߻ෳ ύෳ ࡕෳ. 2.33±0.22 1.5±0.263 7.328 1.71±0.23 1.73±0.21 1.08±0.28 1.85±0.25. ɀ. 0.017. ဎ๞ ɀ. 0.002. ⧋ЈჍӗ. ߻ෳ ύෳ ࡕෳ. 0.79±0.29 0.27±0.15 1.809 0.04±0.04 0 0.21±0.11 0.08±0.08. Value are mean±SD.;. 35. ɀ. Pɦ0.05. 0.177.

(46) ߄ 4.3ǵဉगੱ‫ރ‬ໆ߄Ӛ໨ୖኧϩ‫݋‬Ȑ௨ନሷगᆅȑ. ಔ໔ ᡂ໨. F. p. ߡઝ. 4.74. 0.013. १ኅόਁ. 4.481. 0.016. ဎ๞. 7.488. 0.002. ⧋ЈჍӗ. 1.819. 0.175. Value are mean±SD.;. ɀ. ɀ. ɀ. ɀ. Pɦ0.05. 2.5. 2. 1.5 ϩኧ. ჴᡍಔ ჹྣಔ 1. 0.5. 0 ߻ෳ. ύෳ. ࡕෳ. კ 4.6ǵ‫ٿ‬ಔϐߡઝϩኧ่݀Кၨ. 36.

(47) კ 4.7ǵ‫ٿ‬ಔϐߡઝϩኧ่݀Кၨ 2.5. 2. 1.5 ϩኧ. ჴᡍಔ ჹྣಔ 1. 0.5. 0 ߻ෳ. ύෳ. ࡕෳ. კ 4.8ǵ‫ٿ‬ಔϐ१ኅόਁϩኧ่݀Кၨ. 37.

(48) კ 4.9ǵ‫ٿ‬ಔϐ१ኅόਁϩኧ่݀Кၨ 2.5. 2. 1.5 ϩኧ. ჴᡍಔ ჹྣಔ 1. 0.5. 0 ߻ෳ. ύෳ. ࡕෳ. კ 4.10ǵ‫ٿ‬ಔϐဎ๞ϩኧ่݀Кၨ. 38.

(49) კ 4.11ǵ‫ٿ‬ಔϐဎ๞ϩኧ่݀Кၨ. ಃѤ࿯. Ȭᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ȭၗ਑ϩ‫݋‬. EORTC QLQ-C30 (V 3.0) ‫ ޑ‬30 ঁ໨ҞǴёϩࣁ 15 ঁሦୱǴीԖ 5 ঁфૈሦୱȐ᙮ᡏǵ‫ف‬Յǵᇡ‫ޕ‬ǵ௃ᆣ‫཮ޗک‬фૈȑ ǵ3 ঁੱ‫ރ‬ሦୱ Ȑੲമǵੵภǵ⧋ЈჍӗȑ ǵ1 ঁᕴᡏ଼ந‫ݩރ‬/ғ‫ࠔڮ‬፦ሦୱ‫ ک‬6 ঁൂ ΋໨ҞȐ‫ঁ؂‬բࣁ΋ঁሦୱȑǶ ஒӚঁሦୱ‫܌‬хࡴ‫ޑ‬໨Ҟளϩ࣬у٠ନа‫܌‬хࡴ‫ޑ‬໨ҞኧǴջёள ‫ډ‬၀ሦୱ‫ޑ‬ளϩ Ȑಉϩ RSǴRawScoreȑ Ǵջ RSɨ(Q1ɠQ2ɠ…ɠQn)/n0Ƕ ߄ 4.4 ջᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄‫؁߃ޑ‬ၗ਑ϩ‫݋‬Ƕёаว౜߃ ‫؁‬ၗ਑ϩ‫݋‬ਔǴჹྣಔᆶჴᡍಔϐ໔٠คܴᡉ಍ीᏢ΢ৡ౦ (p>0.05)Ƕ 39.

(50) ߄ 4.4ǵᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ၗ਑ϩ‫!݋‬ ໨Ҟ ⧋ЈჍӗ. ߡઝ. ဎᘞ. १ኅόਁ. ᅵ઀. ੵภ. ਻ߦ. ᙮ᡏфૈ. ‫ف‬Յфૈ. ௃ᆣфૈ. ᇡ‫ޕ‬фૈ. ‫཮ޗ‬фૈ. ᕴ଼ந‫ݩރ‬ ࿶ᔮ֚ᜤ. ಔձ. F. p. 1.41. 0.125. 0.59. 0.262. 0.36. 0.584. 2.9. 0.849. 1.74. 0.799. 8.27. 0.042. 10.29. 0.825. 3.83. 0.011ɀ. 1.12. 0.016ɀ. 10.32. 0.062. 6.09. 0.012. 4.19. 0.040ɀ. 0.93. 0.990. 0.36. 0.086. M±SD. ჹྣಔ. 1.87±0.972. ჴᡍಔ. 1.17±1.32. ჹྣಔ. 2.07±1.21. ჴᡍಔ. 1.50±0.93. ჹྣಔ. 1.71±0.99. ჴᡍಔ. 2.00±1.41. ჹྣಔ. 2.86±1.03. ჴᡍಔ. 2.75±1.58. ჹྣಔ. 2.64±1.08. ჴᡍಔ. 2.50±1.51. ჹྣಔ. 2.50±1.05. ჴᡍಔ. 1.46±1.47. ჹྣಔ. 1.86±0.95. ჴᡍಔ. 1.75±1.28. ჹྣಔ. 3.39± 1.06. ჴᡍಔ. 1.77±1.74. ჹྣಔ. 3.47±1.06. ჴᡍಔ. 1.88±1.84. ჹྣಔ. 2.60±1.08. ჴᡍಔ. 1.60±1.57. ჹྣಔ. 2.33±1.05. ჴᡍಔ. 1.21±1.12. ჹྣಔ. 3.03±1.06. ჴᡍಔ. 1.75±1.77. ჹྣಔ. 1.63±0.95. ჴᡍಔ. 1.63±2.01. ჹྣಔ. 2.93±1.07. Value are mean±SD.; 40. ɀ. p<0.05. ɀ. ɀ.

(51) ಃϖ࿯. Ȭғࢲࠔ፦ຑ՗߄ȭၗ਑ϩ‫݋‬. ғࢲࠔ፦ຑ՗ϩኧ‫ޑ‬ଯե Ȑຑ՗ੰΓ‫ي‬ᡏࢲ୏фૈ‫ޑ‬Б‫ݤ‬ȑ Ǵж߄ ‫ݯ‬ᕍ߻ࡕғࢲࠔ፦‫ؼ‬ӳᆶցǴёբࣁᕎੱੰ஻‫ޑ‬ғӸϷғࢲࠔ፦‫ޑ‬ຑ՗ ࡰ኱Ƕё٬ҔаΠຑ՗߄ٰຑ՗‫ݯ‬ᕍ߻ࡕੰ௃‫ׯ‬๓௃‫׎‬Ǵӵ‫ݯ‬ᕍࡕ‫ޑ‬ຑ ՗ϩኧၨ‫ݯ‬ᕍ߻ගϲਔǴ߄Ңா‫ੰޑ‬௃ςԖᕇள‫ׯ‬๓Ƕ z ٩Ᏽ ECOG ‫ޑ‬኱ྗǴղᘐੰ஻‫ޑ‬ՉࣁૈΚ‫ݩރ‬Ǵа،‫ੰۓ‬஻ ࢂց፾ӝௗ‫ݯڙ‬ᕍǶ z а ECOG ຑ՗ࢲ୏фૈளϩࣁ 0ǵ1 ‫ ܈‬2 ‫ੰޑ‬ΓǴᔈ๏ϒϯ Ꮲ‫ݯ‬ᕍ ߄ 4.5 ջғࢲࠔ፦ຑ՗߄‫؁߃ޑ‬ၗ਑ϩ‫݋‬Ƕёаว౜߃‫؁‬ၗ਑ϩ‫݋‬ ਔǴჹྣಔᆶჴᡍಔϐ໔٠คܴᡉҭค಍ीᏢ΢ৡ౦ (p>0.05)Ƕ. ߄ 4.5ǵғࢲࠔ፦ຑ՗߄ϩ‫݋‬. ჹྣಔ. ჴᡍಔ. M±SD. M±SD. 3.385±0.506. 3.000. ғࢲࠔ፦ຑ՗߄. Grade. Value are mean±SD.; p<0.05 ɀ. 41. p 0.247.

(52) ಃϖക ૸ፕ ΋ǵᕎ҃ߡઝ‫ݩރ‬ᆶᎻТᜪЗภᏊ٬Ҕ ΋ጇ 2008 ԃ‫ޑ‬Шж (cohort) ࣴ‫ࡰز‬р 23ǴԖ 72ʘ ᕎ҃ੰ஻‫ڀ‬Ԗ ߡઝੱ‫ރ‬ǴԶ೯த೿ೀ౛όӳǶԶᕎ҃ߡઝ௼ဂύǴ89ʘ ‫ޑ‬Γόёᗉ խӦ೿ሡा೬ߡᏊ‫ޑ‬٬ҔǶࣴ‫ࡰز‬рǴᕎ҃ੰ஻٬Ҕ༏ଢ଼ЗภǴӸӧ࣬ ྽ε‫ঁޑ‬ᡏৡ౦ǺԖ٤Γ٠ό཮ߡઝǴ‫܌‬аόሡ٬ҔҺՖ೬ߡᏊǹԖ٤ Γό཮ߡઝǴࢂӢࣁдॺܺҔ೬ߡᏊǹԶ‫׳‬Ԗ٤ੰ஻Ԗߡઝ֚ᘋջߡࢂ ς࿶ܺҔଯᏊໆ‫ޑ‬೬ߡᏊǶҞ߻ࣁЗǴϝ҂Ԗܴዴ‫زࣴޑ‬ѐ᠘ձ೭ኬ‫ޑ‬ ঁᡏৡ౦Ƕ Βǵ௨ନచҹ೛࿼૸ፕ ӆஒࣴ‫ز‬ਢගൔΓᡏ၂ᡍ‫ہ‬঩(IRB)ҙፎਔǴҗ‫ܭ‬ҁࣴ‫ز‬ीฝ‫܌‬٬Ҕ ‫ޑ‬ҔᛰࢂᐚᕭࣽᏢύᛰǴ྽ύ֖Ԗ࣬྽К‫ٯ‬ϐᐘણԋϩǴࢂࡺቩਡ‫ہ‬঩ ᇡ‫ۓ‬ᔈ྽௨ନ‫ڀ‬Ԗᑗֿੰ‫ޑ‬ᕎ҃஻‫ޣ‬Ǵаᗉխӧ‫ݯ‬ᕍၸำύǴ೷ԋՈᑗ ୃଯϐୋբҔǶ Οǵຑ՗Б‫ݤ‬ ߡઝੱ‫ޑރ‬ፕ‫ۓ‬ǴਔதࢂЬᢀ‫ޑ‬Ǵҁࣴ‫ز‬ᒧ᏷ȨӼჱྣៈ၂ᒤीฝȩ ύ‫ࠔޑ‬፦ᅱ௓ࡰ኱բࣁᅱෳ኱ྗǴΏࢂӢࣁӧᕎ҃ੰΓ΢Ԗ๱όᒱ‫ߞޑ‬ ਏࡋǴӕਔёаᅱෳӭ໨ဉगфૈࡰ኱Ƕ Կ‫ܭ‬ᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ (EORTC QLQ-C30 V3.0) ‫ޑ‬٬. 42.

(53) ҔǴΏࢂύᙴ၂ᒤीฝύѸा‫ޑ‬ຑໆπ‫ڀ‬ǴЎ᝘ύ 6, 70 ΨගϷǴऍ୯१ ࠔᆶᛰ‫ނ‬ᆅ౛ֽ (FDA)Ǵς࿶ܴዴೕ‫ۓ‬ஒғ‫ࠔڮ‬፦բࣁ‫ל‬ᕎཥᛰຑሽ‫ޑ‬ Ѹ໪໨Ҟϐ΋Ƕ Զғࢲࠔ፦ຑ՗߄ (ECOG: Eastern Cooperative Oncology Group Performance Status)ǴΨࢂύᙴ၂ᒤीฝύѸा‫ޑ‬ຑໆπ‫ڀ‬Ǵՠ‫ځ‬ຑϩ໨ Ҟ๱ख़‫ݯܭ‬ᕍ߻ࡕੰ஻ঁΓࢲ୏ࡋ‫ׯ‬๓ᆶցǴଞჹҁࣴ‫܌ز‬ा௖૸‫ߡޑ‬ ઝϷဉगੱ‫ׯރ‬๓௃‫׎‬ຑ՗Ǵշ੻όεǶ Οǵε໳Ғ૛෯ᕍਏ૸ፕ аύᙴᒣੱࡘᆢԶ‫ق‬Ǵε໳Ғ૛෯Ώ‫ݯ‬ᕍύขჴੱ஻‫ޣ‬ϐဉगੱ ‫ރ‬ǴԶӧӼჱ‫ޑ‬ᕎ҃ੰΓ௼ဂύǴܺҔᎻТᜪЗภᏊԶᇨวߡઝੱ‫ރ‬ ‫ޣ‬Ǵᖏ‫׉‬΢ᢀჸǴዴჴаୃჴੱ‫ࣁރੱޑ‬ЬǴ‫܌‬а٬Ҕε໳Ғ૛෯Ԗ‫ځ‬ ᕍਏǶԶӧҞ߻‫س‬಍‫܄‬Ў᝘ϩ‫݋‬ൔᏤ 71ǴςԖ٬ҔҜΠ‫ݙ‬৔ methylnaltrexoneǴҔа‫ׯ‬๓࿶җܺҔᎻТᜪЗภᏊ‫܌‬Ꮴठ‫ߡޑ‬ઝੱ‫ރ‬Ǵ ՠࢂԜᛰ‫ޑ‬ҔᛰӼӄ‫܄‬ϝ҂ֹӄຑ՗ǶԶҁࣴ‫ز‬٬Ҕε໳Ғ૛෯Ǵᗨฅ ٬Ҕ‫ࢂޑ‬ፄБύᛰǴՠಔԋѝԖε໳ᆶғҒ૛‫ښٿ‬ύᛰǴБᏊಔԋፄᚇ ࡋեǴϩ‫݋‬ၨࣁܴዴϷൂપǶ ӆ‫ޣ‬Ǵҁࣴ‫؂ز‬ВࣽᏢύᛰҔᛰᏊໆѝԖε໳ 2 լख़ǴғҒ૛ 0.5 լख़Ǵ΋Ϻᕴीໆࣁ 2.5 լख़Ǵϩ‫؂‬ВѤԛ๏ᛰǴ‫؂‬ԛ๏ᛰѝԖ 0.625 լख़Ǵᛰ‫ނ‬ᏊໆᇸǴଞჹᕎ҃ੰ஻ဉगၰ֎ԏό٫௃‫׎‬ǴёаᗉխӢ๏. 43.

(54) ᛰᏊໆၸख़Ǵ‫܌‬೷ԋ֎ԏόуǴࣗԿᇨว‫߈׳‬΋‫⧋؁‬ЈǵჍӗ௃‫׎‬ǹӆ ‫ޣ‬Ǵᛰ‫ނ‬ԋҁե༹Ǵੰ஻ॄᏼᇸ༾Ƕ Ѥǵҁࣴ‫ز‬಍ी่݀૸ፕ 1ǵӧȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱‫ޑ‬ᡂϯ΢Ǵ‫ॺך‬ନΑࣴ ‫ز‬ЬᚒǴߡઝࡰ኱ӈΕຑ՗ѦǴ‫ॺך‬ӕਔયΕ१ኅόਁࡰ኱ǵ⧋ЈჍӗ ࡰ኱Ϸဎ๞ࡰ኱Ǵவ಍ी่݀΢य़ٰ࣮Ǵߡઝࡰ኱ǵ१ኅόਁࡰ኱Ϸဎ ๞ࡰ኱Ǵ֡Ԗၲ‫ډ‬಍ीᏢ΢ཀကǴ೭ӧᖏ‫ݯ׉‬ᕍ΢Ǵ‫ڀ‬Ԗख़ाཀကǶа ύᙴ౛ፕԶ‫ق‬Ǵߡઝǵ१ኅόਁϷဎ๞Ǵ֡ឦύข੃ϯၰੱ‫ރ‬ǴԶύข ӧғ౛ཀက΢ǴԖ๱ϲమ໚फ़ᐜ഍Ǵϲ๠໚फ़गᐜϐख़ाғ౛ཀကǴ๠ ໚όϲगᐜόफ़ຎࣁฤǴฤੱВΦԶᜢ਱բǴ‫܌‬аǴε໳Ғ૛෯ᗨࣁ१ ςջӗҥБǴՠᖏ‫ࡰ׉‬ᏤཀကǴࠅࢂࣁҬ೯ύขҥ‫ݤ‬ǶԶ٬‫ॺך‬ӣ៝Ȭ໾ ൣፕȭύǴ໚ܴੰጇԖ΋ख़ाࡰᏤচ߾ǴջȬ΢ȐขȑΠȐขȑ֋ᆃǴ ྽ፕ‫ݯ‬ύขǶȭ Զ⧋ЈჍӗࡰ኱҂‫ܴـ‬ᡉ಍ी΢ཀကǴᆶ‫ڂ‬ᝤ΢٬Ҕε໳Ғ૛෯‫ޑ‬ ࡰ኱ੱ‫ރ‬Ԗ‫܌‬ৡ౦Ǵ೭٬‫ॺך‬ӣ៝ᕎ҃ੰ஻೷ԋ⧋ЈჍӗ‫ޑ‬ӢનύǴН ϩ‫ک‬ႝှ፦Ѩதǵ౦தಥН౜ຝǵᛰ‫ނ‬Ӣન(ᎻТᜪЗภᛰ)аϷᆒઓข ቾǴ֡ࢂቹៜЬӢǴԶ྽‫ൂॺך‬પ٬Ҕε໳Ғ૛෯Ǵाӧอਔ໔ϣֹӄ ௨ନ೭٤ቹៜӢનǴዴჴԖ‫ځ‬ᜤೀǴ‫܌‬аǴஒӧ҂ٰࣴ‫ز‬೛ीύǴуΕ ೭‫ݯ‬ᕍ‫ޑ‬ԵໆǶ. 44.

(55) 2ǵӧȬᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄ȭ (EORTC QLQ-C30 V 3.0)ࡰ ኱‫ޑ‬ᡂϯ΢Ǵ30 ঁ໨ҞύǴёϩࣁ 15 ঁሦୱǴԖ 5 ঁфૈሦୱȐ᙮ ᡏǵ‫ف‬Յǵᇡ‫ޕ‬ǵ௃ᆣ‫཮ޗک‬фૈȑ ǵ3 ঁੱ‫ރ‬ሦୱȐੲമǵੵภǵ⧋ ЈჍӗȑ ǵ1 ঁᕴᡏ଼ந‫ݩރ‬/ғ‫ࠔڮ‬፦ሦୱ‫ ک‬6 ঁൂ΋໨ҞǶၗ਑ϩ‫݋‬ ᡉҢǴфૈሦୱύ‫ޑ‬᙮ᡏǵ‫ف‬Յǵᇡ‫཮ޗکޕ‬фૈ໨ҞԖᡉ๱಍ीᏢཀ က (pɦ0.05) Ϸੱ‫ރ‬ሦୱύ‫ੵޑ‬ภ໨ҞԖᡉ๱಍ीᏢཀက (pɦ0.05)Ƕ೭ ኬ‫ޑ‬಍ी่݀Ǵ٬‫׳ॺך‬уዴᇡǴύᙴᛰ‫ݯޑ‬ᕍϟΕӼჱᕍៈǴࢂԖ҅ य़ཀက‫ޑ‬ǴҭջǴёа‫ڐ‬շᕎ҃ੰΓӧΓғಖࢤਓำਔǴၲ‫ډ‬ӄΓᙴᕍ ᕍៈ‫ޑ‬Ҟ኱ǶԶቩຎҁࣴ‫ز‬ύ‫܌‬ा௖‫ޑز‬ဉगੱ‫ރ‬໨ҞǴхࡴߡઝǵ१ ኅǵ⧋ЈჍӗϷဎᘞǴᗨฅ҂ၲ಍ीᏢ΢ཀကǴࠅᡣ‫ॺך‬຾΋‫؁‬౛ှ‫ډ‬Ǵ ࣴ‫ز‬຾ՉϐਔǴᒧ᏷፾྽ໆ߄‫ޑ‬ख़ा‫܄‬Ƕ‫ॺך‬ӣ៝Ȭᕎੱੰ஻ғ‫ڮ‬፦ໆ ෳ‫ۓ‬ໆ߄ȭ྽ύ‫ޑ‬ୢᚒБԄගрᔠ૸ǶЎύୢเБԄ֡ӭҔȨමག‫ࢌډ‬ ࢌੱ‫…ރ‬ȩ‫ࢂ܈‬ȨමᜤаӵՖ…ȩ฻࿶ᡍԄเᚒБԄǴჹᕎ҃ੰΓԶ‫ق‬Ǵ ёаᇥࢂ΋‫ޔ‬ӧᎁၶࢌ٤ੱ‫ރ‬Ǵ‫܌‬аǴଞჹဉगੱ‫ރ‬໨ҞǴϟΕ߻‫ޑ‬ୢ ‫ڔ‬เਢᆶϟΕࡕ‫ޑ‬ୢ‫ڔ‬เਢǴৡ౦࣬ৡόεǶ 3ǵӧғࢲࠔ፦ຑ՗߄ (ECOG: Eastern Cooperative Oncology Group Performance Status) ࡰ኱‫ޑ‬ᡂϯ΢Ǵҗ‫ܭ‬ୢᚒ๱౳‫ੰܭ‬஻Չ୏य़ӛຑ ՗ǴϟΕ߻‫ޑ‬ຑ՗ᆶϟΕࡕ‫ޑ‬ຑ՗Ǵҭค಍ीᏢ΢ཀကǶ. 45.

(56) ಃϤക ่ፕ ҁࣴ‫ز‬᛾ჴǴε໳Ғ૛෯ዴჴёа‫ׯ‬๓Ӽჱੰ‫܊‬ᕎ҃ੰ஻‫ߡޑ‬ઝੱ ‫ރ‬Ǵӕਔҭё‫ׯ‬๓ੰ஻१ኅόਁϷဎ๞฻ဉगੱ‫ރ‬Ƕᖏ‫׉‬΢Ǵᕎ҃ੰ஻ ဉगੱ‫ׯރ‬๓Ǵዴჴ‫҃ܭ‬යғࢲࠔ፦‫ׯ‬๓Ǵග‫ٮ‬Α΋ঁ࣬྽‫ڀ‬Ԗཀက‫ޑ‬ ࡰ኱Ƕ җ‫ܭ‬ᕎ҃ੰ஻‫ߡޑ‬ઝੱ‫ܭރ‬౜ϞӼჱᕍៈύϝࢂ΋εፐᚒǴӢԜ҂ ٰ৖ఈёаԖ൳εБӛǺ 1ǵ ҁࣴ‫ঁޑز‬ਢኧၨϿǴ҂ٰࣴ‫ز‬ϝ࡭ុ຾ՉǴ‫׆‬ᏇૈԖ‫׳‬ εໆ‫ޑ‬ԏਢǴ߈΋‫଺؁‬р‫׳‬Ԗ᛾ᏵΚ‫ޑ‬ᖏ‫ࡰ׉‬ЇǶ 2ǵ ຾΋‫؁‬ଞჹόӕᕎ҃ੱ‫ރ‬Ǵӵੵภǵᅵ઀ምᛖǵขቾ฻ੱ ‫ރ‬Ǵ຾Չ‫׳‬εೕኳϐࣴ‫ز‬Ƕ 3ǵ аε໳Ғ૛෯բࣁᕎ҃ੰ஻ܺҔᎻТᜪЗภᏊ‫܌‬Ꮴठ‫ߡޑ‬ ઝੱ‫ރ‬ϐ‫ݯ‬ᕍБԄǴКၨ٬Ҕ methylnaltrexone ٰ‫ݯ‬ᕍҗᎻТ ᜪЗภᏊ‫܌‬Ꮴठ‫ߡޑ‬ઝੱ‫ރ‬Ƕ. 46.

(57) ୖԵЎ᝘ 1. Thomas JR, von Gunten CF. Management of constipation in patients with cancer. Support Cancer Ther 2004;2:47-51. 2. Clemens KE, Klaschik E. Management of constipation in palliative care patients. Curr Opin Support Palliat Care 2008;2:22-27. 3. ৪ߎ๸, ഋ‫ۏ‬։, මДᗪ, ໳᐀ঢ়, ໳ඁऍ. ဎ೽࿶๎ᆒ‫ࡪݨ‬ነ‫ׯ‬๓ ҃යੰΓߡઝԋਏϐӃ០ࣴ‫ز‬: ᆵ᡼ៈ౛Ꮲ཮; 2009;5:256-264. 4. Clemens KE, Klaschik E. Managing opioid-induced constipation in advanced illness: focus on methylnaltrexone bromide. Ther Clin Risk Manag 2010;6:77-82. 5. Չࡹଣፁғ࿿. Ӽჱᕍៈ᏾ӝ‫ྣ܄‬ៈયΕӄ଼҇நߥᓀ๏б၂ᒤी ฝ. In; 95 ԃ 1 Д 1 ВঅुಃΒ‫ހ‬:22-25. 6. ࿤஖๮, ഋܴమ, ஭ᔾࣔ, ෯Ꮲ‫ؼ‬, ‫ۏ‬ᛏ, ஭᐀ᑅ. ᕎੱ஻‫ޣ‬ғ‫ڮ‬፦ ໆෳ‫ۓ‬ໆ߄ EORTC QLQ-C30 ύЎ‫ހ‬ຑϟ: ჴҔဍዦᚇᇞ‫ޗ‬ጓᒠ೽; 2005;4:353-355. 7. Reville B, Axelrod D, Maury R. Palliative care for the cancer patient. Prim Care 2009;36:781-810. 8. Noguera A, Centeno C, Librada S, Nabal M. Clinical use of oral laxatives in palliative care services in Spain. Support Care Cancer 2010;18:1491-1494. 9. Larkin PJ, Sykes NP, Centeno C, et al. The management of constipation in palliative care: clinical practice recommendations. Palliat Med 2008;22:796-807. 10. Yu CT, Ko NY. [Evidence-based nursing care for cancer patients with opioid-induced constipation]. Hu Li Za Zhi 2010;57:100-105. 11. Leppert W. The role of opioid receptor antagonists in the treatment of 47.

(58) opioid-induced constipation: a review. Adv Ther 2010;27:714-730. 12. Fallon M, O'Neill B. ABC of palliative care. Constipation and diarrhoea. BMJ 1997;315:1293-1296. 13. Goodman M, Low J, Wilkinson S. Constipation management in palliative care: a survey of practices in the United kingdom. J Pain Symptom Manage 2005;29:238-244. 14. Fallon MT, Hanks GW. Control of common symptoms in advanced cancer. Ann Acad Med Singapore 1994;23:171-177. 15. Fallon MT, Hanks GW. Morphine, constipation and performance status in advanced cancer patients. Palliat Med 1999;13:159-160. 16. ླྀฐ, ܴ݅ች. ҃යੰΓத‫ـ‬ဉगੱ‫ރ‬ᆶೀ౛: ଼நЎϯ٣཰ިҽ Ԗज़Ϧљ; 2010. 17. ӄ଼҇நߥᓀֽ. ӄ଼҇நߥᓀဍዦ஻‫ޣ‬Ћೌǵϯᕍǵ‫ܫ‬৔ጕᕍ‫ݤ‬ ࡕՋᙴՐଣੰ஻ύᙴᇶշᙴᕍ၂ᒤीฝ. ӄ଼҇நߥᓀֽ; 100 ԃ. 18. ‫ޙ‬ᐪ, 㜤‫ذ‬ϻ. 䛽䶁䞄ᧃ‫؁߃ޑ‬௖侚. ቶܿ༾ໆϡનࣽᏢ 2006;13:67-68. 19. ៝ഖࡾ, ࡼ҉ᑫ. ᖏಖᜢᚶ‫کزࣴޑ‬ว৖౜‫ރ‬: Шࣚགࢉᚇᇞጓᒠ ೽; 2004;2:207-210. 20. ݅ችЎ. ጗‫ک‬ᙴᕍઝỊ. Ѡч: ӝ૶; 2003;139-145. 21. ယ‫ה‬ಹ, ഌख़ໜ, ֆ‫ە‬ᗶ. ᕎ҃஻‫ޑޣ‬गဉҔᛰ ဍዦ஻‫ޣ‬Ћೌǵϯᕍǵ‫ܫ‬৔ጕᕍ‫ޑࡕݤ‬ύᙴ‫ݯ‬ᕍ. Ӽჱᕍៈᚇᇞ 2001;6:27-31. 22. Myotoku M, Nakanishi A, Kanematsu M, et al. Reduction of opioid side effects by prophylactic measures of palliative care team may result in improved quality of life. J Palliat Med 2010;13:401-406. 23. Droney J, Ross J, Gretton S, Welsh K, Sato H, Riley J. Constipation in cancer patients on morphine. Support Care Cancer 2008;16:453-459.. 48.

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(60) ଍ 21 ‫ٯ‬ᕍਏᢀჸ. ᔭԀᙴᏢଣᏢൔ 1994:372-373. 40. ஭៌ம, ໳ԓ, ܿ‫ݓ‬. ε໳Ғ૛෯Ⴃٛೌӟဉഞ◰ᖏ‫׉‬ᢀჸ. ύ୯ύ Ջᙴ่ӝѦࣽᚇ‫ ד‬1998:320. 41. ఉӀӹ, ஭ᡦ. “१ςջӗ‫ޣ‬,ε໳Ғ૛෯Ьϐ”ᒣ‫݋‬. ύᙴᛰᖏ‫׉‬ᚇ‫ד‬ 2007:537. 42. ᑊࡌै, ጯࢅҲ, ယቼጪ. Ƞઓၭҁ૛࿶ȡΠ‫ݤ‬ჹࡕШ‫ޑ‬ቹៜ. ჴҔ ύᙴϣࣽᚇ‫ ד‬2008:14-15. 43. ҡৱᗱ. Ƞઓၭҁ૛࿶ȡࣴ‫ز‬ᄔᒵ. ຦໚ύᙴᏢଣᏢൔ 2005:45-48. 44. ύ૛ᛰҔᛰӼӄ. Չࡹଣፁғ࿿ύᙴᛰ‫ہ‬঩཮. (Accessed at http://tcam.ccmp.gov.tw/meun_know_1_content.asp?aaa=14.) 45. ‫׵‬ᇻ, Ц՚դ, ഋ◖ি, ‫ص‬λ‫ݞ‬. λႵჹε໳ᘞΠբҔౢғऐ‫܄ڙ‬ᆶ ဉၰ䀝䆉ᡂϯᜢ‫ޑس‬ໆ-ਔ-ਏᜢ‫زࣴس‬. ᒩჱύᙴᚇ‫ ד‬2010:2444-2447. 46. ‫׵‬ᡦ࣓, Цߏ݅, ᇳࡌѳ. όӕε໳‫ڋ‬Ꮚ‫ޑ‬ᘞΠբҔ၂ᡍ. ύ୯ᛌᙴ ᚇ‫ ד‬2009:48-49. 47. ᛿݊ғ, ‫ڬ‬Ꮲै. ғε໳ྞనᆶғε໳ણჹλႵᘞΠբҔ‫ޑ‬Кၨࣴ ‫ز‬. ෫ࠄৣणεᏢᏢൔ(ᙴᏢ‫ )ހ‬2009:60-61. 48. ಷԢૈ. ε໳‫ޑ‬ЬाԋϩϷ‫ځ‬ᖏ‫׉‬ᛰ౛ࣴ‫ز‬຾৖. Ջࠄैᙴ 2009:931-933. 49. ஭ችࣔ, ‫׹‬ᝬᏯ, ۙ‫ࣂذ‬. ҸඳᔈҔε໳ೕࡓ߃௖. ύᙴࣴ‫ز‬ 2001:15-16. 50. ৖ߪѳ, ླྀཥԃ. ஭ҸඳᔈҔε໳༾௖. Ӏܴύᙴ 2008:922-923. 51. ‫׵‬኷ѳ. భፋ஭Ҹඳჹε໳ၮҔϐ‫ݤ‬. ߙੇᙴᛰᚇ‫ ד‬1998:48-49. 52. Ц࢙݊, ቅԮስ. ၂ፕε໳ӧᖏ‫׉‬΢‫֮ޑ‬Ҕ. Ѥούᙴ 2007:41-42. 53. ᇳऍᄪ, ቅང࣓. ғε໳ણ‫ݯ‬ᕍύ॥ߡઝ. ৎ৥ࣽ‫ מ‬2003:29. 54. ླྀ‫҇ۯ‬. ε໳‫ޑ‬ᖏ‫׉‬ၮҔ. ‫܍‬ቺᙴᏢଣᏢൔ 1994:47-48. 55. ᚟ࡌ๮. ε໳‫ޑ‬ᛰ౛բҔϷᖏ‫׉‬ᔈҔ. ࠍჱᏢଣᏢൔ(ᙴᏢ‫)ހ‬ 50.

(61) 2009:368. 56. ‫׵‬ҏ‫ک‬. ε໳ᛰჹ‫ޑ‬ᖏ‫زࣴ׉‬. ਔࣔ୯ᙴ୯ᛰ 2008:3042-3403. 57. ஭ᓉ. Ƞ໾ൣᚇੰፕȡύε໳‫ૈ܄‬ᆶਏҔ‫ޑ‬ᜢ‫س‬௖૸. Ӏܴύᙴ 2003:7-8. 58. ঐᙴғ. ߏයܺҔε໳ԖϙΧୋբҔ. ৎ৥ࣽ‫ מ‬2003:27. 59. च௵, इϓՋ. ߡઝ᛾‫ ݯ‬཈Ҕε໳. ԢՋύᙴᛰ 2004:45. 60. ‫ྻ׵‬, ቅҷ϶. ε໳‫ࢥޑ‬ୋբҔࣴ‫ز‬. ύ୯ᛰ‫ ܊‬2006:710-712. 61. ஭㯖ᅴ, Цቼ୯, ஞ଼, ቅ௵. வȠઓၭҁ૛࿶ȡচЎፋҸඳБჹҒ ૛‫ޑ‬ၮҔ. ч٧ύᙴᛰεᏢᏢൔ 2006:85-86. 62. ஭ဘૐ, Ֆཥች. ၂ፕȠ໾ൣፕȡჹȠઓၭҁ૛࿶ȡᛰ‫ނ‬Ꮲ‫ޑ‬ᝩ‫ک܍‬ ว৖. ਔࣔ୯ᙴ୯ᛰ 2006:1149-1151. 63. ύ૛ᛰҔᛰӼӄ. Չࡹଣፁғ࿿ύᙴᛰ‫ہ‬঩཮. (Accessed at http://tcam.ccmp.gov.tw/meun_1_content.asp?aaa=9.) 64. ஭ֻБ. ύᛰҒ૛բࣁ“٬ᛰ”‫ޑ‬ೕࡓ௖૸. ὨՋύᙴᏢଣᏢൔ 2010:5-7. 65. ԙ‫ذ‬๩. Ғ૛Ϸ‫़ځ‬ғ‫ޑނ‬ᖏ‫׉‬ᔈҔ. ૐ‫ޜ‬ૐϺᙴᛰ 2010:580-581. 66. Ц‫ݓ‬ើ. Ғ૛ᖏ᛾ᔈҔభ௖. ύ୯҇௼҇໔ᙴᛰ 2009:23. 67. ቅӼᓪ, ଯࡏҥ. ύᛰΜΖϸᖏ‫׉‬ᔈҔ௖૸. Ӏܴύᙴ 2010:2121-2122. 68. ৪ང๮. ৪ε╕“ᛰԖ஑ߏ”ࡘགྷ௖‫݋‬. ύᙴࣴ‫ ز‬2010:78-79. 69. ஭ྷ, ‫׵‬ഓఘ, бઢ๩. భፋȠߎ჆ाౣЈ‫ڂ‬ȡ‫ޑ‬Ꮲೌࡘགྷ. ύ๮ύ ᙴᛰᏢт 2010:2174-2175. 70. Johnson JR, Temple R. Food and Drug Administration requirements for approval of new anticancer drugs. Cancer Treat Rep 1985;69:1155-1159. 71. Candy B, Jones L, Goodman ML, Drake R, Tookman A. Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database Syst Rev 2011:CD003448. 51.

(62) ߕᒵ 1ǵȨӼჱྣៈ၂ᒤीฝȩࠔ፦ᅱ௓ࡰ኱ ΋ǵ ่ᄬࡰ኱ ԖᜢȨ่ᄬय़ȩϐ೛‫ۓ‬Ǵமፓ‫ࢂޑ‬ග‫ٮ‬Ӽჱᕍៈ‫܌‬Ѹሡ٩ᒘ‫ޑ‬ᐒᄬᕉნǵ ಔᙃǵ೛ࡼǵၮբБԄϷၗྍǾ฻Ǵ٠ୖԵӼჱᕍៈՐଣǵۚৎᕍៈೕ ጄ኱ྗǴ֖ࡴ‫ځ‬ύ‫ޑ‬໨Ҟӵ‫׫‬ΕӼჱᕍៈ‫ޑ‬ი໗ΓΚ‫ݩރ‬ǵი໗Γ঩ၗ ਱ᆶ૽ግǴӵፁғ࿿ߥ଼ೀ‫܌‬ᔕϐȨՐଣӼჱᕍៈ೛࿼୷ྗȩǶ Βǵ ၸำࡰ኱ Ȩၸำय़ȩ๱ख़‫ࢂޑ‬ග‫ٮ‬ӼჱᕍៈਔǴวғ‫ੰܭ‬ΓϷი໗Γ঩໔‫ޑ‬ᕍៈࢲ ୏ǴӵΠӈΜΎ໨ϐϩ‫݋‬Ƕ Οǵ ่݀ࡰ኱ Ȩ่݀य़ȩࢂࡰӢӼჱᕍៈ‫܌‬ග‫୍ܺޑٮ‬٬ੰΓҞ߻‫܈‬ஒٰ‫଼ޑ‬ந‫ރ‬ᄊ วғ‫่݀ޑ‬ǴӵੰΓʏৎឦΓαᏢǵੰΓ੯ੰᆶᙴᕍ࣬ᜢၗ਑Ƕ. 52.

(63) 53.

(64) 54.

(65) 55.

(66) 56.

(67) ߕᒵ 2ǵӼჱੰ‫ੰ܊‬஻ϐ१ኅόਁຑ՗ໆ߄. 57.

(68) 58.

(69) ߕᒵ 3ǵᕎੱੰ஻ғ‫ڮ‬፦ໆෳ‫ۓ‬ໆ߄. 59.

(70) 60.

(71) ߕᒵ 4ǵғࢲࠔ፦ຑ՗߄ȐECOG: Eastern Cooperative Oncology Group Performance Statusȑ. 61.

(72) ߕᒵ 5ǵӕཀᖏ‫׉‬၂ᡍ᛾ܴਜ. 62.

(73) 63.

(74) DaHuang GangTsao Tang to improve the constipation syndrome of cancer patients in late-stage: A pilot study. Yu-De Liu Major professorǺJaung-Geng Lin Insitute of Chinese Medical Science, China Medical University, Taiwan, R.O.C. ABSTRACT. Constipation is a severe and common symptom among late-stage cancer patients, and it causes great the anxiety for the patient's family. Terminal cancer patients receive morphine to reduce the pain syndrome also cause constipation, poor appetite and abdominal fullness very easily. And the laxative doesn’t work so well to treat this kind of constipation. This is a single-blinded, randomized controlled trail pilot study. The patients were included in the hospice of Changhua Christian Hospital. There were 27 patients included and separated them into the experimental and the control groups. We use the herbal medicine DaHuang GangTsao Tang to the patients four times a day and last for 6 days. The quality index of Hospice care trail, questionnaire of EORTC QLQ-C30 V3.0 and questionnaire of ECOG are used to evaluate the outcome measure. The conclusion showed that the herbal medicine DaHuang GangTsao 64.

(75) Tang can improve the constipation, poor appetite and abdominal fullness syndrome and reach significant statistical meaning.. Key wordǺconstipation, terminal cancer, Da Huang Gan Cao Tang, palliative care. 65.

(76)