Streptokinaza u komplikovanoj pleuralnoj efuziji u deceBoris T. Kovačević¹, Milka M. Mićić-stanojević² ¹Pedijatrijska bolnica, Kliničko-bolnički centar Zemun-Beograd ²Bolnica za dečje plućne bolesti i tuberkulozu, KBC "dr dragiša Mišović-dedinje" Beograd Apstrakt U pedijatrijskoj praksi poslednjih godina uočena je povećana učestalost pleuralnih efuzija. Prema nači-nu nastanka pleuralne efuzije su podeljene na eksudate i transudate. U grupi eksudata najčešće se sreću parapneumonične efuzije i empijem. Parapneumonična efuzija kod dece definiše se obično kao nakupljanje pleuralne tečnosti u toku akutne bakterijske pneumonije, a ređe u sklopu virusne pneumonije i tuberkuloznog pleuritisa. Empijem označava prisustvo purulentnog sadržaja u pleuralnom prostoru. Glavni bakterijski uzročnik pneumonija udruženih s izlivom je streptococcus pneumoniae serotip 1. Kod 10% bolesnika ne dolazi do povlačenja pleuralne efuzije i pored konzervativnog lečenja. Tada sprovodimo standardizovan postupak prema smernicama BTs vodiča, sa algoritmom dijagnostičko-terapijskih mera. signifikantna količina pleuralne tečnosti koja perzistira i kompromituje plućnu funkciju čini komplikovanu pleuralnu efuziju i indikovana je torakalna drenaža. Pri pojavi septacija i lokulacija u pleuralnom prostoru, neophodna je intrapleuralna instilacija fibrinolitika. Primena streptokinaze je bezbedna, efikasna, smanjuje potrebu za hirurškim lečenjem i zajedno sa ostalim terapijskim merama dovodi do kompletnog oporavka deteta. rana video-asistirana torakoskopija u kombinaciji sa fibrinoliticima verovatno će u budućnosti biti metoda izbora. AbstractFor the past few years an increase in incidence of pleural effusion has been observed in pediatric practise. Pleural effusions are divided according to the way of aappearance in two groups: exudates and transudates. The most common exudates are parapneumonic effusion and enpyem. Parapneumonic effusion is usually defined in children as accumulation of pleural fluid during the acute bacterial pnuemonia and rarely in association with viral pneumonia and tuberculous pleuritis. Empyema shows the presence of pus in the pleural space. streptococcus pneumoniae serotype 1 is the leading pathogen in pneumonias associated with pleural effusions. Pleural effusions in 10 % of patients are not diminished, despite conservative treatment. In this case, we use standard diagnostic therapy management according to recommendations from BTs guidelines. If a significant amount of pleural liquid persists and lung function has been compromited, then we are speaking about complicated pleural effusion and chest drainage is indicated. If septations and loculations appear in pleural space, intrapleural instillation of fibrinolytics is necessary. Using streptokinase is safe and effective, reduces the need for surgical treatment and when combined with other therapy managements, it leeds to complete recovery of the child. Early video-assisted thoracoscopy combined with the use of fibrinolitics will be most choosen method in future.Key words: pleur...