diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/mapper/InpatientDrugMapper.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/mapper/InpatientDrugMapper.java
index 997939a79..7f9d034c5 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/mapper/InpatientDrugMapper.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/mapper/InpatientDrugMapper.java
@@ -52,28 +52,26 @@ public interface InpatientDrugMapper {
                                @Param("operator") String operator);
 
     /**
-     * 汇总单 UPSERT：累计药品发放/退药数量
-     *
-     * 表结构（示例）：
-     *   inpatient_drug_dispense_summary
-     *   - order_id   BIGINT
-     *   - drug_id    BIGINT
-     *   - total_quantity INT   // 正负累计
-     *   - update_time DATETIME
-     *
-     * 主键 (order_id, drug_id) 用于 ON DUPLICATE KEY UPDATE。
+     * 汇总单 UPSERT：如果已存在对应 order_id、drug_id 的汇总记录，则累计 quantity；
+     * 否则插入新记录。此方法用于在同一事务内保持明细与汇总的一致性。
      *
      * @param orderId   医嘱ID
      * @param drugId    药品ID
-     * @param quantity  本次发药或退药数量（正负均可）
+     * @param quantity  本次操作的数量（正数为发药，负数为退药）
+     * @param operator  操作人
      */
-    @Insert("INSERT INTO inpatient_drug_dispense_summary " +
-            "(order_id, drug_id, total_quantity, update_time) " +
-            "VALUES (#{orderId}, #{drugId}, #{quantity}, NOW()) " +
-            "ON DUPLICATE KEY UPDATE " +
-            "total_quantity = total_quantity + VALUES(total_quantity), " +
-            "update_time = NOW()")
+    @Insert({
+        "<script>",
+        "INSERT INTO inpatient_drug_dispense_summary (order_id, drug_id, total_quantity, last_operator, last_update_time) ",
+        "VALUES (#{orderId}, #{drugId}, #{quantity}, #{operator}, NOW()) ",
+        "ON DUPLICATE KEY UPDATE ",
+        "total_quantity = total_quantity + #{quantity}, ",
+        "last_operator = #{operator}, ",
+        "last_update_time = NOW()",
+        "</script>"
+    })
     int upsertDrugDispenseSummary(@Param("orderId") Long orderId,
                                   @Param("drugId") Long drugId,
-                                  @Param("quantity") Integer quantity);
+                                  @Param("quantity") Integer quantity,
+                                  @Param("operator") String operator);
 }
diff --git a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/service/impl/InpatientDrugServiceImpl.java b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/service/impl/InpatientDrugServiceImpl.java
index 78f0d9fac..f5395fd02 100644
--- a/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/service/impl/InpatientDrugServiceImpl.java
+++ b/openhis-server-new/openhis-application/src/main/java/com/openhis/web/inpatient/service/impl/InpatientDrugServiceImpl.java
@@ -53,8 +53,8 @@ public class InpatientDrugServiceImpl implements InpatientDrugService {
             // 插入明细（正向数量）
             drugMapper.insertDrugDispenseDetail(orderId, drugId, quantity, operator);
 
-            // 更新/插入汇总单（正向累计）
-            drugMapper.upsertDrugDispenseSummary(orderId, drugId, quantity);
+            // 更新/插入汇总单，使用相同的数量（正数）
+            drugMapper.upsertDrugDispenseSummary(orderId, drugId, quantity, operator);
         }
     }
 
@@ -69,7 +69,7 @@ public class InpatientDrugServiceImpl implements InpatientDrugService {
     public void returnDrugs(Long orderId, List<Map<String, Object>> drugList) {
         for (Map<String, Object> drug : drugList) {
             Long drugId = (Long) drug.get("drugId");
-            Integer quantity = (Integer) drug.get("quantity"); // 正数
+            Integer quantity = (Integer) drug.get("quantity"); // 正数表示退药量
             String operator = (String) drug.get("operator");
 
             // 退药数量以负数保存到明细表
@@ -77,7 +77,7 @@ public class InpatientDrugServiceImpl implements InpatientDrugService {
             drugMapper.insertDrugReturnDetail(orderId, drugId, negativeQty, operator);
 
             // 汇总单同样使用负数累计
-            drugMapper.upsertDrugDispenseSummary(orderId, drugId, negativeQty);
+            drugMapper.upsertDrugDispenseSummary(orderId, drugId, negativeQty, operator);
         }
     }
 }