diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java
index c6d99f21..35a4bd76 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/charge/patientcardrenewal/PatientCardRenewalServiceImpl.java
@@ -1,6 +1,14 @@
 package com.openhis.web.charge.patientcardrenewal;
 
+import org.springframework.beans.factory.annotation.Autowired;
 import org.springframework.stereotype.Service;
+import org.springframework.transaction.annotation.Transactional;
+import org.springframework.util.StringUtils;
+
+import com.openhis.administration.domain.PatientIdentifier;
+import com.openhis.administration.service.IPatientIdentifierService;
+import com.openhis.common.enums.IdentifierStatusEnum;
+import com.baomidou.mybatisplus.core.conditions.query.LambdaQueryWrapper;
 
 import lombok.extern.slf4j.Slf4j;
 
@@ -14,30 +22,50 @@ import lombok.extern.slf4j.Slf4j;
 @Slf4j
 public class PatientCardRenewalServiceImpl implements PatientCardRenewalService {
     
+    @Autowired
+    private IPatientIdentifierService patientIdentifierService;
+    
     @Override
+    @Transactional(rollbackFor = Exception.class)
     public boolean renewCard(RenewalRequest request) {
-        // TODO: 这里应该实现真实的换卡业务逻辑
+        log.info("执行患者换卡操作: 患者ID={}, 旧卡号={}, 新卡号={}, 原因={}", 
+                 request.getPatientId(), request.getOldCardNo(), request.getNewCardNo(), request.getReason());
+        
         // 1. 验证参数合法性
+        if (StringUtils.isEmpty(request.getPatientId())) {
+            throw new IllegalArgumentException("患者ID不能为空");
+        }
+
+        if (StringUtils.isEmpty(request.getNewCardNo())) {
+            throw new IllegalArgumentException("新卡号不能为空");
+        }
+        
         // 2. 检查新卡号是否已被使用
-        // 3. 更新患者主表中的卡号信息
-        // 4. 记录换卡日志
-        // 5. 处理相关业务系统的卡号更新
-        
-        // 目前返回模拟结果
-        log.info("模拟执行患者换卡操作: 旧卡号={}, 新卡号={}, 原因={}", 
-                 request.getOldCardNo(), request.getNewCardNo(), request.getReason());
-        
-        // 简单验证：确保旧卡号和新卡号不为空且不相同
-        if (request.getOldCardNo() == null || request.getNewCardNo() == null || 
-            request.getOldCardNo().isEmpty() || request.getNewCardNo().isEmpty()) {
-            throw new IllegalArgumentException("卡号不能为空");
+        LambdaQueryWrapper<PatientIdentifier> queryWrapper = new LambdaQueryWrapper<>();
+        queryWrapper.eq(PatientIdentifier::getIdentifierNo, request.getNewCardNo());
+        PatientIdentifier existingIdentifier = patientIdentifierService.getOne(queryWrapper);
+        if (existingIdentifier != null) {
+            throw new IllegalArgumentException("新卡号已被其他患者使用，请更换新卡号");
         }
         
-        if (request.getOldCardNo().equals(request.getNewCardNo())) {
-            throw new IllegalArgumentException("新卡号不能与旧卡号相同");
+        // 3. 直接使用患者ID作为查询条件
+        Long patientId = Long.parseLong(request.getPatientId());
+        // 4. 通过患者ID查询现有标识信息
+        PatientIdentifier patientIdentifier = patientIdentifierService.selectByPatientId(patientId);
+
+        if (patientIdentifier != null) {
+            // 5. 只更新就诊卡号这一个参数
+
+            patientIdentifier.setIdentifierNo(request.getNewCardNo());
+            patientIdentifierService.updateById(patientIdentifier);
+            log.info("患者ID={} 换卡成功，已更新就诊卡号", patientId);
+        } else {
+            throw new IllegalArgumentException("未找到患者标识信息，无法进行换卡操作");
         }
         
-        // 模拟成功结果
+        // 4. 记录换卡日志 - 可以根据需要扩展日志记录功能
+        // 5. 处理相关业务系统的卡号更新 - 可以根据需要扩展
+        
         return true;
     }
 }
\ No newline at end of file
diff --git a/openhis-server-new/openhis-application/src/main/resources/application-local.yml b/openhis-server-new/openhis-application/src/main/resources/application-local.yml
index 5baccbd8..9042834d 100644
--- a/openhis-server-new/openhis-application/src/main/resources/application-local.yml
+++ b/openhis-server-new/openhis-application/src/main/resources/application-local.yml
@@ -12,7 +12,7 @@ spring:
       # 从库数据源
       slave:
         # 从数据源开关/默认关闭
-        enabled: false
+        enabled:
         url:
         username:
         password:
diff --git a/openhis-ui-vue3/src/views/charge/patientCardRenewal/index.vue b/openhis-ui-vue3/src/views/charge/patientCardRenewal/index.vue
index 8b153774..9270b32c 100644
--- a/openhis-ui-vue3/src/views/charge/patientCardRenewal/index.vue
+++ b/openhis-ui-vue3/src/views/charge/patientCardRenewal/index.vue
@@ -142,14 +142,32 @@
     <!-- 患者列表对话框 -->
     <el-dialog
       v-model="showPatientList"
-      title="患者列表"
+      :title="null"
       width="800px"
       :close-on-click-modal="false"
+      class="custom-patient-dialog"
     >
+      <!-- 自定义标题栏和按钮区域 -->
+      <template #header>
+        <div style="width: 100%; background-color: #e6f4ff;">
+          <!-- 标题行 -->
+          <div style="display: flex; justify-content: flex-start; align-items: center; padding: 10px 20px;">
+            <h3 style="margin: 0; font-size: 16px; font-weight: 500; color: #303133;">病人档案查询</h3>
+          </div>
+          <!-- 按钮行 -->
+          <div style="display: flex; justify-content: flex-start; gap: 10px; padding: 10px 20px; background-color: #e6f4ff;">
+            <el-button type="primary" @click="confirmSelectPatient" style="background-color: #409eff; border-color: #409eff; padding: 8px 16px; font-size: 14px;">确认(Q)</el-button>
+            <el-button @click="showPatientList = false; selectedPatient = null" style="background-color: #f56c6c; border-color: #f56c6c; color: white; padding: 8px 16px; font-size: 14px;">关闭(C)</el-button>
+          </div>
+        </div>
+      </template>
+      
       <el-table 
         :data="patientList" 
         style="width: 100%" 
         @row-click="selectPatient"
+        :row-key="row => row.identifierNo || row.patientId || row.cardNo"
+        :current-row-key="selectedPatient?.identifierNo || selectedPatient?.patientId || selectedPatient?.cardNo"
         highlight-current-row
       >
         <el-table-column label="序号" width="60" type="index">
@@ -196,7 +214,7 @@
         <el-pagination
           v-model:current-page="currentPage"
           v-model:page-size="pageSize"
-          :page-sizes="[10, 20, 50, 100]"
+          :page-sizes="[5, 10, 20, 50, 100]"
           layout="total, sizes, prev, pager, next, jumper"
           :total="total"
           @size-change="handleSizeChange"
@@ -204,10 +222,9 @@
         />
       </div>
       
+      <!-- 移除底部按钮 -->
       <template #footer>
-        <span class="dialog-footer">
-          <el-button @click="showPatientList = false">取消</el-button>
-        </span>
+        <span></span>
       </template>
     </el-dialog>
     
@@ -233,10 +250,16 @@
 </template>
 
 <script setup>
-import { ref, reactive, onMounted, onUnmounted } from 'vue'
-import { ElMessage } from 'element-plus'
+import { ref, reactive, onMounted, onUnmounted, getCurrentInstance } from 'vue'
+import { ElMessage, ElMessageBox } from 'element-plus'
+import { useRouter } from 'vue-router'
 import { doCardRenewal, getPatientList } from './components/api.js';
 
+// 获取路由实例
+const router = useRouter();
+// 获取当前组件实例以访问全局属性
+const { proxy } = getCurrentInstance();
+
 // 搜索表单
 const searchForm = reactive({
   patientName: '',
@@ -250,9 +273,10 @@ const patientInfo = ref(null)
 // 患者列表
 const patientList = ref([])
 const showPatientList = ref(false)
+const selectedPatient = ref(null)
 // 分页相关状态
 const currentPage = ref(1)
-const pageSize = ref(10)
+const pageSize = ref(5)
 const total = ref(0)
 
 // 换卡表单
@@ -270,6 +294,7 @@ const renewalSuccessVisible = ref(false)
 const handleSizeChange = (newSize) => {
   pageSize.value = newSize
   currentPage.value = 1 // 重置为第一页
+  selectedPatient.value = null // 切换分页时重置选中状态
   if (showPatientList.value) {
     handlePatientSearch() // 重新查询
   }
@@ -278,6 +303,7 @@ const handleSizeChange = (newSize) => {
 // 当前页码变化处理
 const handleCurrentChange = (newPage) => {
   currentPage.value = newPage
+  selectedPatient.value = null // 切换分页时重置选中状态
   if (showPatientList.value) {
     handlePatientSearch() // 重新查询
   }
@@ -306,32 +332,30 @@ const handleCurrentChange = (newPage) => {
       const response = await getPatientList(queryParams)
       
       if (response && response.code === 200) {
-        // 检查是否有查询结果
-        if (response.data && response.data.records && response.data.records.length > 0) {
-          // 更新总条数
-          total.value = response.data.total || 0
-          
-          // 如果只有一条记录且是第一页，直接显示
-          if (response.data.records.length === 1 && currentPage.value === 1) {
+      // 检查是否有查询结果
+      if (response.data && response.data.records && response.data.records.length > 0) {
+        // 更新总条数
+        total.value = response.data.total || 0
+        selectedPatient.value = null // 查询时重置选中状态
+        
+        // 如果只有一条记录且是第一页，自动选中
+        if (response.data.records.length === 1 && currentPage.value === 1) {
             const patient = response.data.records[0]
-              
-            // 获取门诊号码，优先使用identifierNo或patientId
-            const outpatientNo = patient.identifierNo || patient.cardNo || patient.card_number || patient.就诊卡号 || patient.outpatientNumber || patient.outpatientNo || patient.门诊号码 || patient.卡号 || patient.card || patient.patientNo || patient.patient_id;
-            // 获取性别，优先使用genderEnum_enumText
-            const gender = patient.genderEnum_enumText || patient.gender || patient.sex || patient.性别 || patient.xb || patient.sexCode || patient.GENDER || patient.SEX;
-              
-            patientInfo.value = {
-              outpatientNo: outpatientNo,
-              patientName: patient.patientName || patient.name,
-              idCard: patient.idCard || patient.id_card || patient.idNo,
-              phoneNumber: patient.phoneNumber || patient.phone || patient.mobile || patient.mobilePhone,
-              gender: gender,
-              age: patient.age,
-              patientId: patient.patientId || outpatientNo
+            // 确保patient对象中同时包含id和patientId字段
+            if (patient.id && !patient.patientId) {
+              patient.patientId = patient.id;
             }
+              
+            // 设置为选中状态，但不自动确认
+            selectedPatient.value = patient
+            ElMessage.warning('已自动选中唯一患者，请点击确定')
           } else {
             // 如果有多条记录或不是第一页，显示患者列表供选择
-            patientList.value = response.data.records
+            // 确保每条患者记录都包含patientId字段，优先使用id字段
+            patientList.value = response.data.records.map(patient => ({
+              ...patient,
+              patientId: patient.patientId || patient.id
+            }))
             showPatientList.value = true
           }
         } else {
@@ -344,8 +368,11 @@ const handleCurrentChange = (newPage) => {
       }
       
     } catch (error) {
-      ElMessage.error('查询失败，请稍后重试')
+      // 使用公共错误处理函数处理错误信息
+      const errorMessage = processErrorMessage(error, '查询失败，请稍后重试');
+      ElMessage.error(errorMessage);
       // 可以在这里添加错误监控或日志记录
+      console.error('患者查询错误:', error);
     } finally {
       loading.value = false
     }
@@ -384,31 +411,66 @@ const handleConfirm = async () => {
     
     if (res && res.code === 200) {
       renewalSuccessVisible.value = true
+      // 更新患者信息中的门诊号码为新号码
+      if (patientInfo.value) {
+        patientInfo.value.outpatientNo = renewalForm.newOutpatientNo
+      }
       ElMessage.success('换卡成功！')
     } else {
       ElMessage.error('换卡失败：' + (res?.msg || '未知错误'))
     }
     
   } catch (error) {
-    ElMessage.error('换卡失败，请稍后重试')
+    ElMessage.error('换卡失败，卡号已存在')
     // 可以在这里添加错误监控或日志记录
   } finally {
     loading.value = false
   }
 }
 
-// 关闭窗口
+// 关闭窗口，同时关闭标签页并返回上一级页面
 const handleClose = () => {
-  if (confirm('确定要关闭换卡窗口吗？')) {
-    resetForm()
-    // 如果是在弹窗中打开的，可以添加关闭弹窗的逻辑
-    // 否则可以导航回上一页
-    // this.$router.back()
-  }
+  // 显示确认对话框
+  ElMessageBox.confirm('确定要关闭此页面吗？', '提示', {
+    confirmButtonText: '确定',
+    cancelButtonText: '取消',
+    type: 'warning'
+  }).then(() => {
+    // 用户确认后，使用全局$tab对象关闭当前标签页
+    if (proxy && proxy.$tab) {
+      proxy.$tab.closePage()
+    } else {
+      // 降级处理：如果$tab不可用，仍然使用router.back()
+      router.back()
+    }
+  }).catch(() => {
+    // 用户取消操作，不执行任何操作
+    // 可以选择显示一个提示消息
+    ElMessage.info('已取消关闭操作')
+  })
 }
 
 // 键盘事件处理
 const handleKeydown = (event) => {
+  // 只有在患者列表对话框显示时才处理对话框快捷键
+  if (showPatientList.value) {
+    // 忽略在输入框中按下的按键
+    if (event.target.tagName === 'INPUT' || event.target.tagName === 'TEXTAREA') {
+      return
+    }
+    
+    const key = event.key.toLowerCase()
+    if (key === 'q') {
+      event.preventDefault()
+      confirmSelectPatient()
+    } else if (key === 'c') {
+      event.preventDefault()
+      showPatientList.value = false
+      selectedPatient.value = null
+    }
+    return
+  }
+  
   // Alt + Q 查询
   if (event.altKey && event.key.toLowerCase() === 'q') {
     event.preventDefault()
@@ -429,6 +491,17 @@ const handleKeydown = (event) => {
 // 组件挂载时添加键盘事件监听
 onMounted(() => {
   document.addEventListener('keydown', handleKeydown)
+  
+  // 设置默认患者数据，方便用户直接进行换卡操作
+  patientInfo.value = {
+    outpatientNo: '20231001001',
+    patientName: '张三',
+    idCard: '110101199001011234',
+    phoneNumber: '13800138000',
+    gender: '男',
+    age: '33岁',
+    patientId: '1001'
+  }
 })
 
 // 组件卸载时移除键盘事件监听
@@ -437,26 +510,41 @@ onUnmounted(() => {
 })
 
 // 移除了调试功能
+  
+  // 选择患者（仅设置选中状态）
+const selectPatient = (row) => {
+  selectedPatient.value = row
+  ElMessage.warning('已选择患者，请点击确定')
+}
 
-// 选择患者
-  const selectPatient = (row) => {
-      // 获取门诊号码，优先使用identifierNo
-      const outpatientNo = row.identifierNo || row.cardNo || row.card_number || row.就诊卡号 || row.outpatientNumber || row.outpatientNo || row.门诊号码 || row.卡号 || row.card || row.patientNo || row.patient_id;
-      // 获取性别，优先使用genderEnum_enumText
-      const gender = row.genderEnum_enumText || row.gender || row.sex || row.性别 || row.xb || row.sexCode || row.GENDER || row.SEX;
-      
-      patientInfo.value = {
-        outpatientNo: outpatientNo,
-        patientName: row.patientName || row.name,
-        idCard: row.idCard || row.id_card || row.idNo,
-        phoneNumber: row.phoneNumber || row.phone || row.mobile || row.mobilePhone,
-        gender: gender,
-        age: row.age,
-        patientId: row.patientId || outpatientNo
-      }
-    showPatientList.value = false
-    ElMessage.success('已选择患者：' + (row.patientName || row.name))
+// 确认选择患者
+const confirmSelectPatient = () => {
+  if (!selectedPatient.value) {
+    ElMessage.warning('请先选择患者')
+    return
   }
+  
+  const row = selectedPatient.value
+  // 获取门诊号码，优先使用identifierNo
+  const outpatientNo = row.identifierNo || row.cardNo || row.card_number || row.就诊卡号 || row.outpatientNumber || row.outpatientNo || row.门诊号码 || row.卡号 || row.card || row.patientNo || row.patient_id;
+  // 获取性别，优先使用genderEnum_enumText
+  const gender = row.genderEnum_enumText || row.gender || row.sex || row.性别 || row.xb || row.sexCode || row.GENDER || row.SEX;
+  
+  patientInfo.value = {
+    outpatientNo: outpatientNo,
+    patientName: row.patientName || row.name,
+    idCard: row.idCard || row.id_card || row.idNo,
+    phoneNumber: row.phoneNumber || row.phone || row.mobile || row.mobilePhone,
+    gender: gender,
+    age: row.age,
+    patientId: row.patientId || row.id || outpatientNo
+  }
+  
+  showPatientList.value = false
+  ElMessage.success('已选择患者：' + (row.patientName || row.name))
+  // 重置选中状态
+  selectedPatient.value = null
+}
 
 // 重置表单
   const resetForm = () => {
@@ -466,10 +554,11 @@ onUnmounted(() => {
     patientInfo.value = null
     patientList.value = []
     showPatientList.value = false
+    selectedPatient.value = null
     renewalForm.newOutpatientNo = ''
     // 重置分页状态
     currentPage.value = 1
-    pageSize.value = 10
+    pageSize.value = 5
     total.value = 0
   }
   
@@ -491,27 +580,28 @@ onUnmounted(() => {
 </script>
 
 <style scoped>
-/* 对话框标题样式 */
-.el-dialog__header {
-  background-color: #fff;
-  padding: 15px 20px;
-  border-bottom: 1px solid #ebeef5;
-  margin: 0;
+/* 自定义对话框样式 */
+.custom-patient-dialog .el-dialog__header {
+  padding: 0;
+  border-bottom: none;
+  height: auto;
 }
 
-.el-dialog__title {
-  font-size: 16px;
-  color: #303133;
-  font-weight: 500;
+/* 隐藏默认的header样式 */
+.custom-header {
+  display: none;
 }
 
-/* 按钮样式 */
-.dialog-footer {
-  display: flex;
-  justify-content: center;
-  padding: 15px 20px;
-  background-color: #fff;
-  border-top: 1px solid #ebeef5;
+.custom-patient-dialog .el-dialog__body {
+  padding: 0;
+  max-height: 60vh;
+  overflow-y: auto;
+}
+
+/* 隐藏默认底部区域 */
+.custom-patient-dialog .el-dialog__footer {
+  padding: 0;
+  border-top: none;
 }
 
 .dialog-footer .el-button {
@@ -541,7 +631,24 @@ onUnmounted(() => {
   text-align: left;
 }
 
-/* 恢复默认表格样式 */
+/* 表格样式优化 */
+.el-table {
+  margin: 0;
+}
+
+.el-table th {
+  background-color: #f5f7fa;
+  font-weight: 500;
+  color: #303133;
+  text-align: center;
+  border-bottom: 1px solid #ebeef5;
+}
+
+.el-table td {
+  text-align: center;
+  border-bottom: 1px solid #ebeef5;
+}
+
 .el-table tr:hover > td {
   background-color: #f5f7fa;
 }
@@ -550,6 +657,14 @@ onUnmounted(() => {
   background-color: #fafafa;
 }
 
+/* 分页样式优化 */
+.el-pagination {
+  margin-top: 10px;
+  padding: 10px 20px;
+  background-color: #fafafa;
+  border-top: 1px solid #ebeef5;
+}
+
 .card-renewal-container {
   width: 100%;
   max-width: 800px;