fix(health): 审计修复 — alert 时序 + outbox 幂等性

1. CRITICAL: check_vital_signs_alert 移至 insert 之后执行，
   防止数据未持久化就触发告警
2. CRITICAL: send_system 添加 business_id 幂等检查，
   防止 outbox relay 重放导致重复消息通知
3. 修复 consent_service unused_mut 警告

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());

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,