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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
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