236 lines
11 KiB
Markdown
236 lines
11 KiB
Markdown
# Bug #715 诸葛亮分析报告
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> **文档类型**: Bug分析
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> **分析时间**: 2026-06-13 02:38:26
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> **分析模型**: mimo-v2.5 (LLM深度分析)
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---
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## 基本信息
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- **Bug #**: 715
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- **标题**: 【住院护士站-医嘱校对】医生已签发的“临时耗材医嘱”未同步至护士站“医嘱校对”界面
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- **模块**: 病区护士工作站
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- **提出人**: 陈显精
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---
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Now I have all the information needed. Let me write the comprehensive analysis.
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---
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## 一、Bug 理解
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**禅道 Bug 标题**：【住院护士站-医嘱校对】医生已签发的"临时耗材医嘱"未同步至护士站"医嘱校对"界面
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**重现步骤**：
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1. 医生端：进入"住院医生工作站"，为患者刘潇凡开具并手动点击【签发】一条"临时"医嘱（如：一次性使用导尿包）
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2. 护士端：进入"住院护士站" > "医嘱校对"界面
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3. 在"未校对"标签页中，选中患者，点击【查询】
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**期望结果**：系统应正确加载并显示已签发的临时耗材医嘱，以便护士进行核对操作。
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**实际结果**：医嘱核对页面显示空白，提示"点击查询获取患者医嘱信息"，无法查到已签发的临时耗材医嘱。
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**附图关键信息**：
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- 截图1（医生端）：显示患者刘潇凡有一条状态为"**已签发**"的临时医嘱"一次性使用导尿包"，类别为"耗材"，金额 38.00 元
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- 截图2（护士端）："医嘱校对 → 未校对"页面，患者已选中但右侧**内容区域完全空白**，仅显示"点击查询获取患者医嘱信息"
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**综合总结**：医生签发的耗材医嘱（存储在 `wor_device_request` 表）在护士站医嘱校对页面无法查询到，因为该页面的 SQL 查询只包含了药品请求（`med_medication_request`）和服务请求（`wor_service_request`）两个 UNION 子查询，**完全缺失了耗材请求（`wor_device_request`）的第三个 UNION 子查询**。
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---
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## 二、根因分析
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### 根因定位
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**核心缺陷文件**：`healthlink-his-server/healthlink-his-application/src/main/resources/mapper/inhospitalnursestation/AdviceProcessAppMapper.xml`
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`selectInpatientAdvicePage` 查询使用 UNION 组合三种医嘱类型，但只写了两个子查询：
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| 序号 | 表名 | 医嘱类型 | 状态 |
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|------|------|---------|------|
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| ✅ 1 | `med_medication_request` | 药品医嘱 | 有 |
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| ✅ 2 | `wor_service_request` | 诊疗服务医嘱 | 有 |
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| ❌ 3 | `wor_device_request` | **耗材/器材医嘱** | **缺失** |
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**对比证据**：住院医生站的 `DoctorStationAdviceAppMapper.xml`（行 674-732）和住院医生工作站的 `AdviceManageAppMapper.xml`（行 247-305）都正确包含了 `wor_device_request` 的 UNION 子查询，证明耗材医嘱是系统支持的医嘱类型。
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### 签发流程差异
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从 `AdviceManageAppServiceImpl.java`（行 842-845）可确认：
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- 药品/服务医嘱签发：状态保持 `DRAFT(1)` + 设置 `performer_check_id`
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- **耗材医嘱签发**：状态直接设为 `ACTIVE(2)`（不使用 `performer_check_id`）
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### 涉及文件
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| 文件 | 作用 |
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|------|------|
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| `AdviceProcessAppMapper.xml` | **需修改** — 缺少 `wor_device_request` UNION 子查询 |
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| `AdviceProcessAppServiceImpl.java` | **可能需微调** — `therapyEnum` 条件处理（设备医嘱的 `therapy_enum` 为 NULL） |
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| `InpatientAdviceDto.java` | DTO，已包含 `adviceTable` 字段，可区分医嘱来源表 |
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| `DeviceRequest.java` | 基础实体，注意：**没有** `performerCheckId` 字段 |
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| `CommonConstants.java:150` | 常量 `WOR_DEVICE_REQUEST = "wor_device_request"` 已定义 |
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---
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## 三、修复方案
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### Step 1: 在 `AdviceProcessAppMapper.xml` 中添加第三个 UNION 子查询
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在现有的 `wor_service_request` UNION 之后、`ORDER BY T1.status_enum )` 之前，添加 `wor_device_request` 的 UNION 子查询。需映射到 `InpatientAdviceDto` 的所有字段：
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```xml
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UNION
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( SELECT DISTINCT T1.encounter_id,
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T1.tenant_id,
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#{worDeviceRequest} AS advice_table,
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T1.id AS request_id,
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T1.use_start_time AS start_time,
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T1.use_end_time AS end_time,
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T1.requester_id AS requester_id,
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T1.create_time AS request_time,
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NULL::integer AS skin_test_flag,
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NULL::integer AS inject_flag,
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NULL::bigint AS group_id,
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NULL::bigint AS performer_check_id,
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T2."name" AS advice_name,
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T2.id AS item_id,
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NULL::varchar AS volume,
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T1.lot_number AS lot_number,
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T1.quantity AS quantity,
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T1.unit_code AS unit_code,
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T1.status_enum AS request_status,
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NULL::varchar AS method_code,
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T1.rate_code AS rate_code,
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NULL::numeric AS dose,
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NULL::varchar AS dose_unit_code,
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al1.id AS position_id,
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al1."name" AS position_name,
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NULL::integer AS dispense_per_duration,
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T2.part_percent AS part_percent,
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NULL::varchar AS condition_definition_name,
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NULL::integer AS therapy_enum,
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NULL::integer AS sort_number,
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NULL::integer AS execute_num,
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af.day_times,
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ae.bus_no,
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ap."name" AS patient_name,
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al2."name" AS bed_name,
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ap.gender_enum,
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ap.birth_date,
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ap.id AS patient_id,
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fc.contract_name,
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diagnosis.condition_names,
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pra."name" AS admitting_doctor_name,
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personal_account.balance_amount,
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personal_account.id AS account_id,
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NULL::varchar AS category_code,
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NULL::integer AS dispense_status,
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NULL::numeric AS unit_price,
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NULL::numeric AS total_price,
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NULL::bigint AS stopper_id,
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T1.update_by AS stopper_name
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FROM wor_device_request AS T1
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LEFT JOIN adm_device_definition AS T2
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ON T2.id = T1.device_def_id AND T2.delete_flag = '0'
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LEFT JOIN adm_location AS al1
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ON al1.id = T1.perform_location AND al1.delete_flag = '0'
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LEFT JOIN adm_encounter ae
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ON ae.id = T1.encounter_id AND ae.class_enum = #{imp} AND ae.delete_flag = '0'
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LEFT JOIN adm_patient ap ON ae.patient_id = ap.id AND ap.delete_flag = '0'
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LEFT JOIN adm_encounter_location ael
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ON ae.id = ael.encounter_id AND ael.delete_flag = '0'
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AND ael.status_enum = #{active} AND ael.form_enum = #{bed}
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LEFT JOIN adm_location al2 ON ael.location_id = al2.id AND al2.delete_flag = '0'
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LEFT JOIN adm_account aa
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ON ae.id = aa.encounter_id AND aa.encounter_flag = 1 AND aa.delete_flag = '0'
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LEFT JOIN fin_contract fc ON aa.contract_no = fc.bus_no AND fc.delete_flag = '0'
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LEFT JOIN (
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SELECT aed.encounter_id, STRING_AGG(ccd.name, ', ') AS condition_names
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FROM adm_encounter_diagnosis aed
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INNER JOIN cli_condition cc ON cc.id = aed.condition_id AND cc.delete_flag = '0'
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INNER JOIN cli_condition_definition ccd ON ccd.id = cc.definition_id AND ccd.delete_flag = '0'
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WHERE aed.delete_flag = '0'
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GROUP BY aed.encounter_id
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) AS diagnosis ON ae.id = diagnosis.encounter_id
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LEFT JOIN adm_encounter_participant aep
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ON ae.id = aep.encounter_id AND aep.delete_flag = '0'
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AND aep.status_enum = #{active} AND aep.type_code = #{admittingDoctor}
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LEFT JOIN adm_practitioner pra ON aep.practitioner_id = pra.id AND pra.delete_flag = '0'
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LEFT JOIN (
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SELECT aa.id, aa.encounter_id,
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(aa.balance_amount -
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COALESCE(SUM(CASE WHEN aci.status_enum IN (#{billed}, #{billable})
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THEN aci.total_price ELSE 0 END), 0) +
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COALESCE(SUM(CASE WHEN aci.status_enum = #{refunded}
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THEN aci.total_price ELSE 0 END), 0)) AS balance_amount
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FROM adm_account aa
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LEFT JOIN adm_charge_item aci ON aa.encounter_id = aci.encounter_id AND aa.delete_flag = '0'
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WHERE aa.type_code = #{personalCashAccount} AND aa.delete_flag = '0'
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GROUP BY aa.id, aa.encounter_id, aa.balance_amount
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) AS personal_account ON personal_account.encounter_id = ae.id
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LEFT JOIN adm_frequency af ON af.rate_code = T1.rate_code AND af.delete_flag = '0'
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WHERE T1.delete_flag = '0'
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AND T1.generate_source_enum = #{doctorPrescription}
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AND T1.refund_device_id IS NULL
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AND (T1.based_on_id IS NULL OR T1.based_on_table IS NULL)
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ORDER BY T1.status_enum )
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```
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**关键差异注意**：
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1. `performer_check_id` — 设为 `NULL::bigint`，因为 `wor_device_request` 没有此字段，耗材签发时直接将 `statusEnum` 设为 `ACTIVE(2)`
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2. `therapy_enum` — 设为 `NULL::integer`，因为耗材医嘱没有治疗类型分类
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3. `advice_table` — 使用新的参数 `#{worDeviceRequest}`
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4. WHERE 条件中不需要 `performer_check_id IS NOT NULL` 检查，因为耗材签发后直接为 `ACTIVE(2)` 状态
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5. 需要排除基于其他医嘱生成的执行记录：`AND (T1.based_on_id IS NULL OR T1.based_on_table IS NULL)`
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### Step 2: 修改 `AdviceProcessAppMapper.java` — 添加参数
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在 `selectInpatientAdvicePage` 方法签名中添加 `worDeviceRequest` 参数：
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```java
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Page<InpatientAdviceDto> selectInpatientAdvicePage(
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@Param("page") Page<InpatientAdviceDto> page,
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@Param(Constants.WRAPPER) QueryWrapper<InpatientAdviceParam> queryWrapper,
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@Param("medMedicationRequest") String medMedicationRequest,
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@Param("worServiceRequest") String worServiceRequest,
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@Param("worDeviceRequest") String worDeviceRequest, // 新增
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// ... 其余参数不变
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);
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```
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### Step 3: 修改 `AdviceProcessAppServiceImpl.java` — 传递新参数
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在 `getInpatientAdvicePage` 方法中，调用 mapper 时添加 `CommonConstants.TableName.WOR_DEVICE_REQUEST`：
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```java
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Page<InpatientAdviceDto> inpatientAdvicePage
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= adviceProcessAppMapper.selectInpatientAdvicePage(
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new Page<>(pageNo, pageSize), queryWrapper,
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CommonConstants.TableName.MED_MEDICATION_REQUEST,
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CommonConstants.TableName.WOR_SERVICE_REQUEST,
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CommonConstants.TableName.WOR_DEVICE_REQUEST, // 新增
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RequestStatus.DRAFT.getValue(), ...);
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```
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### Step 4: 确保 `therapyEnum` 条件兼容
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当前代码已修复（行 `queryWrapper.and(w -> w.eq("therapy_enum", therapyEnum).or().isNull("therapy_enum"))`），允许 NULL 的 `therapy_enum` 通过。耗材医嘱的 `therapy_enum` 为 NULL，会匹配 "全部" 和 "临时" 两个筛选条件，这是正确的行为。
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---
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## 四、路由决策
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**FIXER**: `guanyu`（后端开发）
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**REASON**: 此 Bug 为纯后端 SQL 查询缺陷——Mapper XML 中 UNION 缺少 `wor_device_request` 子查询，需修改 XML、Mapper 接口、ServiceImpl 调用三处。前端无需改动，属于后端数据查询层的修复，交给后端开发最合适。
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---
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## 路由决策
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- **FIXER_ID**: guanyu
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- **修复 Agent**: guanyu（后端）
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- **原因**: LLM 分析决策
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> ⚠️ 修复人员请先验证以上分析是否正确，再执行修复。
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