Abstract：
Type A acute aortic dissection (TAAAD) still carries high rates of morbidity and mortality. Outcomes of patients presenting with TAAAD depend on several variables such as the site of intimal rupture, organ malperfusion and extension of surgical repair. Bleeding after surgery for TAAAD is one of the most common complications and it\'s also associated with worse postoperative outcomes. Previous cardiac operations have been associated with a higher rate of postoperative bleeding and also with worse postoperative outcomes in patients undergoing second elective cardiac operations. According to the Stanford system, the most commonly used system of anatomic classification, type A AAD (TA-AAD: DeBakey type I and II) involves the ascending aorta, irrespective of the site of the intimal tear while type B AAD (TB-AAD) does not involve the ascending aorta and propagates downwards distally from the isthmus. Despite recent substantial diagnostic and therapeutic progress, AAD morbidity and mortality remain still high. Blood malperfusion triggers the propagation of aortic dissection, resulting in the ischemia of involved organs. Meanwhile, an excessive inflammatory response occurs, contributing to the development of oxygen impairment. A recent study suggested that inflammation and coagulation are involved in AAD combined ALI. Endothelial and epithelial barriers are destroyed by increased alveolar-capillary barrier permeability, which is responsible for ALI. Furthermore, inflammatory and oxidative stress-related cellular and metabolic regulatory mechanisms might participate in the AAD course worsened by ALI.
摘要：
A型急性主动脉夹层（TAAAD）仍然具有很高的发病率和死亡率。TAAAD患者的预后取决于几个变量，例如内膜破裂的部位，器官灌注不良和手术修复的扩展。TAAAD术后出血是最常见的并发症之一,也与术后不良预后相关。先前的心脏手术与较高的术后出血率有关，并且在进行第二次选择性心脏手术的患者中，术后预后较差。根据斯坦福系统,最常用的解剖分类系统，A型AAD（TA-AAD：DeBakeyI型和II型）涉及升主动脉，无论内膜撕裂的部位如何，而B型AAD（TB-AAD）不涉及升主动脉，并从峡部向远端向下传播。尽管最近取得了实质性的诊断和治疗进展，AAD发病率和死亡率仍然很高。血液灌注不良引发主动脉夹层的传播,导致受累器官缺血。同时,过度的炎症反应发生，促进氧损伤的发展。最近的一项研究表明，AAD合并ALI涉及炎症和凝血。内皮和上皮屏障被肺泡-毛细血管屏障通透性增加破坏，对阿里负责。此外，炎症和氧化应激相关的细胞和代谢调节机制可能参与了ALI恶化的AAD病程。
