diff --git a/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/components/prescriptionList.vue b/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/components/prescriptionList.vue
index 99b7bbbd..05d74322 100755
--- a/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/components/prescriptionList.vue
+++ b/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/components/prescriptionList.vue
@@ -68,9 +68,7 @@
       </div>
     </div>
   </div>
-</template>
-    </div>
-    <div
+  <div
       style="padding: 10px; background-color: #eef9fd; height: 100%; overflow-y: auto"
       v-loading="loading"
     >
@@ -232,7 +230,7 @@ import {adviceCancel, adviceExecute, adviceNoExecute, getPrescriptionList} from
 import {patientInfoList} from '../../components/store/patient.js';
 import {lotNumberMatch} from '@/api/public';
 import {formatDateStr} from '@/utils/index';
-import {getCurrentInstance, nextTick, ref} from 'vue';
+import {getCurrentInstance, nextTick, ref, provide} from 'vue';
 
 const activeNames = ref([]);
 const prescriptionList = ref([]);
@@ -242,6 +240,8 @@ const therapyEnum = ref(undefined);
 const { proxy } = getCurrentInstance();
 const loading = ref(false);
 const chooseAll = ref(false);
+// 独立维护选中行ID集合，避免el-table内部selection状态异常导致联动全选
+const selectedRowIds = ref(new Set());
 const props = defineProps({
   exeStatus: {
     type: Number,
@@ -442,6 +442,7 @@ function handleGetPrescription() {
     chooseAll.value = false;
   } else {
     prescriptionList.value = [];
+    selectedRowIds.value.clear();
     // proxy.$message.warning('请选择患者');
   }
 }
@@ -530,10 +531,14 @@ function handleCancel() {
 }
 
 function getSelectRows() {
-  // 获取选中的医嘱信息
-  let list = [];
-  prescriptionList.value.forEach((item, index) => {
-    list = [...list, ...proxy.$refs['tableRef' + index][0].getSelectionRows()];
+  // 优先从独立维护的selectedRowIds集合中获取选中行，避免el-table内部selection状态异常
+  const list = [];
+  prescriptionList.value.forEach((item) => {
+    item.forEach((row) => {
+      if (selectedRowIds.value.has(row.requestId)) {
+        list.push(row);
+      }
+    });
   });
   return list;
 }
@@ -609,12 +614,14 @@ function handelSwicthChange(value) {
       if (value) {
         // 全选：选中所有行并联动checkbox
         item.forEach((row) => {
+          selectedRowIds.value.add(row.requestId);
           tableRef[0].toggleRowSelection(row, true);
           selectAllCheckboxesInRow(row);
         });
       } else {
         // 取消全选：取消选中所有行并联动checkbox
         item.forEach((row) => {
+          selectedRowIds.value.delete(row.requestId);
           tableRef[0].toggleRowSelection(row, false);
           unselectAllCheckboxesInRow(row);
         });
@@ -625,11 +632,14 @@ function handelSwicthChange(value) {
 
 // 默认选中全部行
 function defaultSelectAllRows() {
+  // 清空并重建选中集合
+  selectedRowIds.value.clear();
   prescriptionList.value.forEach((item, index) => {
     const tableRef = proxy.$refs['tableRef' + index];
     if (tableRef && tableRef[0]) {
       // 选中该表格的所有行
       item.forEach((row) => {
+        selectedRowIds.value.add(row.requestId);
         tableRef[0].toggleRowSelection(row, true);
         // 同时选中该行内部的所有checkbox
         selectAllCheckboxesInRow(row);
@@ -709,13 +719,14 @@ function checkAndToggleRowSelection(row) {
       const tableRef = proxy.$refs['tableRef' + tableIndex];
       if (tableRef && tableRef[0]) {
         const isAllSelected = isAllCheckboxesSelected(row);
-        const selectedRows = tableRef[0].getSelectionRows();
-        const isCurrentlySelected = selectedRows.some((r) => r.requestId === row.requestId);
+        const isCurrentlySelected = selectedRowIds.value.has(row.requestId);
 
         // 根据checkbox状态更新表格行选中状态
         if (isAllSelected && !isCurrentlySelected) {
+          selectedRowIds.value.add(row.requestId);
           tableRef[0].toggleRowSelection(row, true);
         } else if (!isAllSelected && isCurrentlySelected) {
+          selectedRowIds.value.delete(row.requestId);
           tableRef[0].toggleRowSelection(row, false);
         }
       }
@@ -728,9 +739,11 @@ function handleRowSelect(selection, row, tableIndex) {
   const isSelected = selection.some((item) => item.requestId === row.requestId);
 
   if (isSelected) {
+    selectedRowIds.value.add(row.requestId);
     // 选中行时，选中该行内部的所有checkbox
     selectAllCheckboxesInRow(row);
   } else {
+    selectedRowIds.value.delete(row.requestId);
     // 取消选中行时，取消选中该行内部的所有checkbox
     unselectAllCheckboxesInRow(row);
   }
@@ -747,11 +760,13 @@ function handleSelectAll(selection, tableIndex) {
   if (selection.length > 0) {
     // 全选时，选中所有行内部的所有checkbox
     tableData.forEach((row) => {
+      selectedRowIds.value.add(row.requestId);
       selectAllCheckboxesInRow(row);
     });
   } else {
     // 取消全选时，取消选中所有行内部的所有checkbox
     tableData.forEach((row) => {
+      selectedRowIds.value.delete(row.requestId);
       unselectAllCheckboxesInRow(row);
     });
   }
@@ -763,16 +778,12 @@ function handleSelectAll(selection, tableIndex) {
 // 更新全选开关状态
 function updateChooseAllStatus() {
   let allSelected = true;
-  prescriptionList.value.forEach((item, index) => {
-    const tableRef = proxy.$refs['tableRef' + index];
-    if (tableRef && tableRef[0]) {
-      const selectedRows = tableRef[0].getSelectionRows();
-      if (selectedRows.length !== item.length) {
+  prescriptionList.value.forEach((item) => {
+    item.forEach((row) => {
+      if (!selectedRowIds.value.has(row.requestId)) {
         allSelected = false;
       }
-    } else {
-      allSelected = false;
-    }
+    });
   });
   chooseAll.value = allSelected;
 }
diff --git a/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/index.vue b/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/index.vue
index 54c36670..905890e4 100755
--- a/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/index.vue
+++ b/openhis-ui-vue3/src/views/inpatientNurse/medicalOrderExecution/index.vue
@@ -51,7 +51,7 @@
 </template>
 
 <script setup>
-import {getCurrentInstance} from 'vue';
+import {getCurrentInstance, ref, nextTick, provide} from 'vue';
 import PatientList from '../components/patientList.vue';
 import PrescriptionList from './components/prescriptionList.vue';
 import { RequestStatus } from '@/utils/medicalConstants';