diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/regdoctorstation/appservice/impl/AdviceManageAppServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/regdoctorstation/appservice/impl/AdviceManageAppServiceImpl.java
index d18d54b66..957313188 100755
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/regdoctorstation/appservice/impl/AdviceManageAppServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/regdoctorstation/appservice/impl/AdviceManageAppServiceImpl.java
@@ -341,7 +341,7 @@ public class AdviceManageAppServiceImpl implements IAdviceManageAppService {
                 && (DbOpType.INSERT.getCode().equals(e.getDbOpType()) || DbOpType.UPDATE.getCode().equals(e.getDbOpType())))
                 .collect(Collectors.toList());
 
-        // 防重复保存：对新增医嘱进行去重，避免签发单条长期医嘱时产生重复记录
+        // 防重复保存：对所有医嘱进行去重（包括 INSERT 和 UPDATE 混合场景），避免签发单条医嘱时产生重复记录
         Set<String> longUniqueKeySet = new HashSet<>();
         List<RegAdviceSaveDto> longUniqueList = new ArrayList<>();
         for (RegAdviceSaveDto adviceSaveDto : longInsertOrUpdateList) {
@@ -351,10 +351,10 @@ public class AdviceManageAppServiceImpl implements IAdviceManageAppService {
                     + adviceSaveDto.getDose() + "_"
                     + adviceSaveDto.getMethodCode() + "_"
                     + adviceSaveDto.getRateCode();
-            if (DbOpType.INSERT.getCode().equals(adviceSaveDto.getDbOpType()) && longUniqueKeySet.contains(uniqueKey)) {
-                log.warn("防重复保存：检测到重复长期医嘱，跳过保存 - patientId={}, encounterId={}, adviceDefinitionId={}, dose={}",
+            if (longUniqueKeySet.contains(uniqueKey)) {
+                log.warn("防重复保存：检测到重复长期医嘱（跨操作类型），跳过 - patientId={}, encounterId={}, adviceDefinitionId={}, dbOpType={}",
                         adviceSaveDto.getPatientId(), adviceSaveDto.getEncounterId(),
-                        adviceSaveDto.getAdviceDefinitionId(), adviceSaveDto.getDose());
+                        adviceSaveDto.getAdviceDefinitionId(), adviceSaveDto.getDbOpType());
                 continue;
             }
             longUniqueKeySet.add(uniqueKey);
@@ -429,7 +429,7 @@ public class AdviceManageAppServiceImpl implements IAdviceManageAppService {
                 && (DbOpType.INSERT.getCode().equals(e.getDbOpType()) || DbOpType.UPDATE.getCode().equals(e.getDbOpType())))
                 .collect(Collectors.toList());
 
-        // 防重复保存：对新增医嘱进行去重
+        // 防重复保存：对所有医嘱进行去重（包括 INSERT 和 UPDATE 混合场景），避免签发时产生重复记录
         Set<String> tempUniqueKeySet = new HashSet<>();
         List<RegAdviceSaveDto> tempUniqueList = new ArrayList<>();
         for (RegAdviceSaveDto adviceSaveDto : tempInsertOrUpdateList) {
@@ -439,10 +439,10 @@ public class AdviceManageAppServiceImpl implements IAdviceManageAppService {
                     + adviceSaveDto.getDose() + "_"
                     + adviceSaveDto.getMethodCode() + "_"
                     + adviceSaveDto.getRateCode();
-            if (DbOpType.INSERT.getCode().equals(adviceSaveDto.getDbOpType()) && tempUniqueKeySet.contains(uniqueKey)) {
-                log.warn("防重复保存：检测到重复临时医嘱，跳过保存 - patientId={}, encounterId={}, adviceDefinitionId={}, dose={}",
+            if (tempUniqueKeySet.contains(uniqueKey)) {
+                log.warn("防重复保存：检测到重复临时医嘱（跨操作类型），跳过 - patientId={}, encounterId={}, adviceDefinitionId={}, dbOpType={}",
                         adviceSaveDto.getPatientId(), adviceSaveDto.getEncounterId(),
-                        adviceSaveDto.getAdviceDefinitionId(), adviceSaveDto.getDose());
+                        adviceSaveDto.getAdviceDefinitionId(), adviceSaveDto.getDbOpType());
                 continue;
             }
             tempUniqueKeySet.add(uniqueKey);
diff --git a/openhis-server-new/openhis-application/src/main/resources/mapper/inhospitalnursestation/AdviceProcessAppMapper.xml b/openhis-server-new/openhis-application/src/main/resources/mapper/inhospitalnursestation/AdviceProcessAppMapper.xml
index 3aa27ecbd..dbd2b1cd9 100755
--- a/openhis-server-new/openhis-application/src/main/resources/mapper/inhospitalnursestation/AdviceProcessAppMapper.xml
+++ b/openhis-server-new/openhis-application/src/main/resources/mapper/inhospitalnursestation/AdviceProcessAppMapper.xml
@@ -155,7 +155,7 @@
            ii.performer_check_id,
            ii.category_code,
            ii.dispense_status
-    FROM (( SELECT T1.encounter_id,
+    FROM (( SELECT DISTINCT T1.encounter_id,
                    T1.tenant_id,
                    #{medMedicationRequest} AS advice_table,
                    T1.id AS request_id,
@@ -293,7 +293,7 @@
                      T1.sort_number,
                      T1.group_id )
           UNION
-          ( SELECT T1.encounter_id,
+          ( SELECT DISTINCT T1.encounter_id,
                    T1.tenant_id,
                    #{worServiceRequest} AS advice_table,
                    T1.id AS request_id,