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Streptokinaza u komplikovanoj pleuralnoj efuziji u dece

Boris Kovacevic ,
Boris Kovacevic
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Milka Micic-Stanojevic
Milka Micic-Stanojevic
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Published: 01.12.2010.

Biochemistry

Volume 27, Issue 1 (2011)

pp. 232-236;

https://doi.org/10.5937/matmed1101232k

Abstract

U pedijatrijskoj praksi poslednjih godina uočena je povećana učestalost pleuralnih efuzija. Prema načinu 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.

Keywords

pleuralna efuzija,

torakalna drenaža,

streptokinaza,

deca

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