diff --git a/crates/erp-health/src/service/consent_service.rs b/crates/erp-health/src/service/consent_service.rs
index e1ad24f..6c913af 100644
--- a/crates/erp-health/src/service/consent_service.rs
+++ b/crates/erp-health/src/service/consent_service.rs
@@ -23,7 +23,7 @@ pub async fn list_consents(
     let limit = page_size.min(100);
     let offset = page.saturating_sub(1) * limit;
 
-    let mut query = consent::Entity::find()
+    let query = consent::Entity::find()
         .filter(consent::Column::TenantId.eq(tenant_id))
         .filter(consent::Column::PatientId.eq(patient_id))
         .filter(consent::Column::DeletedAt.is_null());
diff --git a/crates/erp-health/src/service/health_data_service.rs b/crates/erp-health/src/service/health_data_service.rs
index 8c76b92..017e411 100644
--- a/crates/erp-health/src/service/health_data_service.rs
+++ b/crates/erp-health/src/service/health_data_service.rs
@@ -86,7 +86,7 @@ pub async fn create_vital_signs(
         .ok_or(HealthError::PatientNotFound)?;
 
     let now = Utc::now();
-    check_vital_signs_alert(state, tenant_id, patient_id, operator_id, req.clone()).await;
+    let alert_req = req.clone();
     let active = vital_signs::ActiveModel {
         id: Set(Uuid::now_v7()),
         tenant_id: Set(tenant_id),
@@ -112,11 +112,15 @@ pub async fn create_vital_signs(
     };
     let m = active.insert(&state.db).await?;
 
+    // 数据持久化成功后再触发危急值检测
+    check_vital_signs_alert(state, tenant_id, patient_id, operator_id, alert_req).await;
+
     audit_service::record(
         AuditLog::new(tenant_id, operator_id, "vital_signs.created", "vital_signs")
             .with_resource_id(m.id),
         &state.db,
-    ).await;
+    )
+    .await;
 
     Ok(VitalSignsResp {
         id: m.id, patient_id: m.patient_id, record_date: m.record_date,
diff --git a/crates/erp-message/src/service/message_service.rs b/crates/erp-message/src/service/message_service.rs
index 88f890f..c3212e7 100644
--- a/crates/erp-message/src/service/message_service.rs
+++ b/crates/erp-message/src/service/message_service.rs
@@ -148,6 +148,9 @@ impl MessageService {
     }
 
     /// 系统发送消息（由事件处理器调用）。
+    ///
+    /// 幂等保证：当 `business_id` 存在时，若同 tenant + recipient + business_id 的消息已存在，
+    /// 直接返回已有消息，避免 outbox relay 重放导致重复通知。
     #[allow(clippy::too_many_arguments)]
     pub async fn send_system(
         tenant_id: Uuid,
@@ -160,6 +163,27 @@ impl MessageService {
         db: &sea_orm::DatabaseConnection,
         event_bus: &EventBus,
     ) -> MessageResult<MessageResp> {
+        // 幂等检查：防止 outbox relay 重放导致重复消息
+        if let Some(bid) = business_id {
+            let existing = message::Entity::find()
+                .filter(message::Column::TenantId.eq(tenant_id))
+                .filter(message::Column::RecipientId.eq(recipient_id))
+                .filter(message::Column::BusinessId.eq(bid))
+                .filter(message::Column::DeletedAt.is_null())
+                .one(db)
+                .await
+                .map_err(|e| MessageError::Validation(e.to_string()))?;
+
+            if let Some(m) = existing {
+                tracing::debug!(
+                    message_id = %m.id,
+                    business_id = %bid,
+                    "消息已存在，跳过重复创建（幂等保护）"
+                );
+                return Ok(Self::model_to_resp(&m));
+            }
+        }
+
         let id = Uuid::now_v7();
         let now = Utc::now();
         let system_user = Uuid::nil();