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·700· 中华骨科杂志2025年6月第45卷第11期 Chin J Orthop, June 2025, Vol.45, No.11
·共 识·
骨科、麻醉科加速康复围手术期患者
慢性病管理专家共识（2025年版）
中国康复技术转化及发展促进会 中华医学会麻醉学分会
中国医师协会麻醉学医师分会 中国研究型医院学会
通信作者：缪长虹，Email: miaochh@aliyun.com；吴新宝，Email: wuxinbao_jst@126.com；
俞卫锋，Email: ywf808@yeah.net；裴福兴，Email: peifuxing@vip.163.com
【摘要】 骨科择期手术中的老年患者常合并一种或多种慢性病及器官功能损害，术后并发症发生率高于年轻患者。
共识聚焦围手术期慢性病器官功能代偿状态的评估与优化，基于美国麻醉医师协会（American Society of Anesthesiologists，
ASA）全身健康状况分级体系，结合循证医学证据与临床实践，提出针对心血管系统疾病（高血压、冠心病、心律失常、心力
衰竭）、呼吸系统疾病、营养风险、代谢性疾病（糖尿病、骨质疏松）、神经精神疾病（认知障碍、睡眠障碍、焦虑抑郁）等围手
术期常见慢性病管理的推荐意见，旨在建立多学科协作的标准化评估流程，通过精准评估器官代偿能力，降低围手术期器
官功能损害与衰竭风险，提高老年患者骨科择期手术的安全性和加速康复。
【关键词】 术后加速康复；疾病管理；循证医学；共识
【共识注册】 PREPARE⁃2025CN389
DOI: 10.3760/cma.j.cn121113-20250123-00073
Expert consensus on chronic disease management in perioperative patients with enhanced recovery after surgery in or⁃
thopaedics and anesthesiology (2025 version)
China Association of Rehabilitation Technology Transformation and Promotion, Chinese Medical Association of Anesthesiology, Chi⁃
nese Medical Doctor Association of Anesthesiologist, Chinese Research Hospital Association
Corresponding author: Miao Changhong, Email: miaochh@aliyun.com; Wu Xinbao, Email: wuxinbao_jst@126.com; Yu Weifeng,
Email: ywf808@yeah.net; Pei Fuxing, Email: peifuxing@vip.163.com
【Abstract】 Elderly patients undergoing elective orthopaedic surgery are often comorbid with one or more chronic diseases
and organ dysfunction and have a higher incidence of postoperative complications than younger patients. Based on the American
Society of Anesthesiologists (ASA) general health status classification system, combined with evidence⁃based medical evidence
and clinical practice, this consensus focuses on the evaluation and optimization of organ function compensation in the periopera⁃
tive period of chronic diseases. Recommendations for the management of common chronic diseases such as cardiovascular diseas⁃
es (hypertension, coronary heart disease, arrhythmia, heart failure), respiratory diseases, nutritional risk, metabolic diseases (diabe⁃
tes, osteoporosis), neuropsychiatric diseases (cognitive impairment, sleep disorders, anxiety and depression) during the periopera⁃
tive period were proposed, aiming to establish a standardized assessment process for multidisciplinary collaboration, in order to re⁃
duce the risk of perioperative organ damage and failure through accurate assessment of organ compensatory capacity, and improve
the safety and accelerated recovery of elderly patients undergoing elective orthopaedic surgery.
【Key words】 Enhanced recovery after surgery; Disease management; Evidence⁃based medicine; Consensus
【Consensus registration】 PREPARE-2025CN389
DOI: 10.3760/cma.j.cn121113-20250123-00073
一、制订背景
慢性病全称为慢性非传染性疾病，是一类起病
隐匿、病程长且病情迁延不愈、缺乏确切传染性生
物病因证据、病因复杂或病因尚不完全明确的疾
病。骨科手术中老年患者逐年增多，常合并贫血、
高血压、冠心病、糖尿病、慢性阻塞性肺疾病、焦虑
症、抑郁症、睡眠障碍、骨质疏松症、营养不良、肝肾
功能不全等慢性病［1-5］，手术创伤易加重器官功能障
碍或导致器官衰竭，甚至引起死亡［6］，且多种慢性病
常共存并伴有器官功能不全［7］。文献报道合并慢性
病的老年患者术后全身性并发症发生的风险高于
年轻患者［8］，因此高龄、合并慢性病将直接影响手术
效果与患者康复［9］。
骨科、麻醉科及其他学科医生在围手术期如何
筛查、评估、优化慢性病的器官功能，增强患者耐受
麻醉与手术的能力，减少并发症与死亡率方面面临
