diff --git a/crates/erp-ai/src/handler/mod.rs b/crates/erp-ai/src/handler/mod.rs
index 0a9f521..b0ffcc7 100644
--- a/crates/erp-ai/src/handler/mod.rs
+++ b/crates/erp-ai/src/handler/mod.rs
@@ -9,6 +9,7 @@ use serde::Deserialize;
 use std::convert::Infallible;
 
 use crate::dto::{AnalysisSseEvent, AnalysisType};
+use crate::service::suggestion::SuggestionService;
 use crate::state::AiState;
 
 // === 分析请求 Body ===
@@ -71,8 +72,10 @@ where
 
     let analysis_id_clone = analysis_id;
     let state_clone = state.clone();
+    let patient_id_clone = uuid::Uuid::nil(); // lab report 场景 patient_id 从 report 关联
+    let doctor_id_clone = ctx.user_id;
 
-    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "lab_report", ctx.tenant_id);
+    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "lab_report", ctx.tenant_id, patient_id_clone, doctor_id_clone);
     Ok(Sse::new(sse_stream).keep_alive(KeepAlive::default()))
 }
 
@@ -140,7 +143,7 @@ where
     let analysis_id_clone = analysis_id;
     let state_clone = state.clone();
 
-    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "trend", ctx.tenant_id);
+    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "trend", ctx.tenant_id, uuid::Uuid::nil(), ctx.user_id);
     Ok(Sse::new(sse_stream).keep_alive(KeepAlive::default()))
 }
 
@@ -197,7 +200,7 @@ where
     let analysis_id_clone = analysis_id;
     let state_clone = state.clone();
 
-    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "checkup_plan", ctx.tenant_id);
+    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "checkup_plan", ctx.tenant_id, uuid::Uuid::nil(), ctx.user_id);
     Ok(Sse::new(sse_stream).keep_alive(KeepAlive::default()))
 }
 
@@ -254,7 +257,7 @@ where
     let analysis_id_clone = analysis_id;
     let state_clone = state.clone();
 
-    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "report_summary", ctx.tenant_id);
+    let sse_stream = build_sse_stream(stream, analysis_id_clone, state_clone, "report_summary", ctx.tenant_id, uuid::Uuid::nil(), ctx.user_id);
     Ok(Sse::new(sse_stream).keep_alive(KeepAlive::default()))
 }
 
@@ -453,6 +456,8 @@ fn build_sse_stream(
     state: AiState,
     analysis_type: &'static str,
     tenant_id: uuid::Uuid,
+    patient_id: uuid::Uuid,
+    doctor_id: uuid::Uuid,
 ) -> impl futures::Stream<Item = Result<Event, Infallible>> {
     async_stream::stream! {
         let mut full_content = String::new();
@@ -491,14 +496,45 @@ fn build_sse_stream(
         let metadata = serde_json::json!({"analysis_type": analysis_type});
         let _ = state.analysis.complete_analysis(analysis_id, full_content.clone(), metadata).await;
 
+        // 解析双通道输出并创建建议记录
+        let parsed = crate::service::output_parser::parse_dual_channel(&full_content).unwrap_or(
+            crate::dto::suggestion::ParsedOutput {
+                text_content: full_content.clone(),
+                structured: None,
+            },
+        );
+
+        let mut event_payload = serde_json::json!({
+            "analysis_id": analysis_id,
+            "analysis_type": analysis_type,
+            "patient_id": patient_id,
+            "doctor_id": doctor_id,
+        });
+
+        if let Some(ref structured) = parsed.structured {
+            event_payload["risk_level"] = serde_json::json!(structured.risk_level.as_str());
+            event_payload["suggestion_count"] = serde_json::json!(structured.suggestions.len());
+
+            if !structured.suggestions.is_empty() {
+                let _ = SuggestionService::create_suggestions(
+                    &state.db,
+                    tenant_id,
+                    analysis_id,
+                    &structured.suggestions,
+                    structured.risk_level,
+                    &structured.baseline_summary,
+                    Some(doctor_id),
+                ).await;
+            }
+        } else {
+            let _ = SuggestionService::mark_parse_failed(&state.db, analysis_id).await;
+        }
+
         // 发布 AI 分析完成事件
         let event = erp_core::events::DomainEvent::new(
             "ai.analysis.completed",
             tenant_id,
-            erp_core::events::build_event_payload(serde_json::json!({
-                "analysis_id": analysis_id,
-                "analysis_type": analysis_type,
-            })),
+            erp_core::events::build_event_payload(event_payload),
         );
         state.event_bus.publish(event, &state.db).await;