合并心脏疾病的患者行普胸外科手术时风险较高，围术期麻醉评估和管理是一大难点，2014年欧、美心脏病学权威机构美国心脏协会(AHA)/美国心脏病学会(ACC)和欧洲心脏病学会(ESC)/欧洲麻醉学学会(ESA)分别发布了心脏病患者非心脏手术围术期评估管理指南，为接受非心脏手术成人患者的围手术期心血管评估和治疗提供指导。该文主要根据上海市胸科医院的临床处理经验对欧美指南加以解读，以期在两个方面为临床医生提供借鉴：一是评估合并心脏疾病的患者哪些因素可能会增加胸科手术围术期发病率和病死率；二是如何设计合理的围术期治疗策略来降低心脏病患者胸科手术时的围术期风险。

Patients with cardiovascular diseases are at high risk for thoracic surgery, and the preoperative risk evaluation and management is usually difficult. In 2014, the authority organization American Heart Association(AHA)/American College of Cardiology(ACC) and European Society of Cardiology(ESC)/European Society of Anaesthesiology(ESA) published new guidelines respectively on cardiovascular assessment and management for non-cardiac surgery and introduced a number of recommendations in the field. The article aims to comment on the two guidelines based on the clinical practice experience in Shanghai Chest Hospital in order to give some recommendations on preoperative evaluation at two aspects. First, it is aimed to identify patients for whom the perioperative period may constitute an increased risk of morbidity and mortality, aside from the risks associated with the underlying disease. Second, it may help to design perioperative strategies to reduce additional perioperative risks.