diff --git a/src/Shentun.Peis.Application/DiagnosisFunctions/DiagnosisFunctionAppService.cs b/src/Shentun.Peis.Application/DiagnosisFunctions/DiagnosisFunctionAppService.cs
index eff2b38..1d3d3e5 100644
--- a/src/Shentun.Peis.Application/DiagnosisFunctions/DiagnosisFunctionAppService.cs
+++ b/src/Shentun.Peis.Application/DiagnosisFunctions/DiagnosisFunctionAppService.cs
@@ -1988,11 +1988,12 @@ namespace Shentun.Peis.DiagnosisFunctions
             if (registerCheckEnt != null)
             {
                 registerCheckEnt.CriticalRangeValue = CriticalRangeValue;
-                registerCheckEnt.IsCriticalValue = isCriticalValue;
+               
                 if (isCriticalValue == 'Y')
                 {
                     registerCheckEnt.CriticalValueCreatorId = _currentUser.Id;
                     registerCheckEnt.CriticalValueCreationTime = DateTime.Now;
+                    registerCheckEnt.IsCriticalValue = isCriticalValue;
                 }
                 registerCheckEnt.FollowUpCreatorId = _currentUser.Id;
                 registerCheckEnt.FollowUpCreationTime = DateTime.Now;
diff --git a/src/Shentun.Peis.Application/FollowUps/FollowUpAppService.cs b/src/Shentun.Peis.Application/FollowUps/FollowUpAppService.cs
index 43c63ec..794690a 100644
--- a/src/Shentun.Peis.Application/FollowUps/FollowUpAppService.cs
+++ b/src/Shentun.Peis.Application/FollowUps/FollowUpAppService.cs
@@ -27,6 +27,8 @@ namespace Shentun.Peis.FollowUps
         private readonly IRepository<SmsSend, Guid> _smsSendRepository;
         private readonly SmsSendAppService _smsSendAppService;
         private readonly IRepository<PatientRegister, Guid> _patientRegisterRepository;
+        private readonly IRepository<RegisterCheck, Guid> _registerCheckRepository;
+        private readonly IRepository<RegisterCheckItem> _registerCheckItemRepository;
         public FollowUpAppService(
             IRepository<FollowUp, Guid> followUpRepository,
             CacheService cacheService,
@@ -34,7 +36,9 @@ namespace Shentun.Peis.FollowUps
             IRepository<PhoneFollowUp, Guid> phoneFollowUpRepository,
             IRepository<SmsSend, Guid> smsSendRepository,
             SmsSendAppService smsSendAppService,
-            IRepository<PatientRegister, Guid> patientRegisterRepository)
+            IRepository<PatientRegister, Guid> patientRegisterRepository,
+            IRepository<RegisterCheck, Guid> registerCheckRepository,
+            IRepository<RegisterCheckItem> registerCheckItemRepository)
         {
             _followUpRepository = followUpRepository;
             _cacheService = cacheService;
@@ -43,6 +47,8 @@ namespace Shentun.Peis.FollowUps
             _smsSendRepository = smsSendRepository;
             _smsSendAppService = smsSendAppService;
             _patientRegisterRepository = patientRegisterRepository;
+            _registerCheckRepository = registerCheckRepository;
+            _registerCheckItemRepository = registerCheckItemRepository;
         }
 
         /// <summary>
@@ -77,42 +83,58 @@ namespace Shentun.Peis.FollowUps
         /// <returns></returns>
         public async Task DeleteByPatientRegisterId(PatientRegisterIdInputDto input)
         {
-            var isFollowUp = await _followUpRepository.FirstOrDefaultAsync(f => f.PatientRegisterId == input.PatientRegisterId);
-            if (isFollowUp != null)
+            //检查是否所有项目都没有
+
+            var isFollowUpDelete = (from patientRegister in await _patientRegisterRepository.GetQueryableAsync()
+                                    join registerCheck in await _registerCheckRepository.GetQueryableAsync() on patientRegister.Id equals registerCheck.PatientRegisterId
+                                    join registerCheckItem in await _registerCheckItemRepository.GetQueryableAsync() on registerCheck.Id equals registerCheckItem.RegisterCheckId
+                                    where patientRegister.Id == input.PatientRegisterId
+                                    && (registerCheck.IsFollowUp == 'Y'
+                                    || registerCheck.IsCriticalValue == 'Y'
+                                    || registerCheckItem.IsCriticalValue == 'Y'
+                                    || registerCheckItem.IsFollowUp == 'Y')
+                                    select patientRegister.Id
+                      ).Count();
+
+            if (isFollowUpDelete == 0)
             {
-                var phoneFollowUpList = await _phoneFollowUpRepository.GetListAsync(m => m.FollowUpId == isFollowUp.Id);
-                var smsSendList = await _smsSendRepository.GetListAsync(m => m.FollowUpId == isFollowUp.Id);
-                bool isDelete = true;  //是否需要删除
-                if (phoneFollowUpList.Any())
+                var isFollowUp = await _followUpRepository.FirstOrDefaultAsync(f => f.PatientRegisterId == input.PatientRegisterId);
+                if (isFollowUp != null)
                 {
-                    isDelete = false;
-                    phoneFollowUpList = phoneFollowUpList.Where(m => m.PlanFollowDate > DateTime.Now).ToList();
+                    var phoneFollowUpList = await _phoneFollowUpRepository.GetListAsync(m => m.FollowUpId == isFollowUp.Id);
+                    var smsSendList = await _smsSendRepository.GetListAsync(m => m.FollowUpId == isFollowUp.Id);
+                    bool isDelete = true;  //是否需要删除
                     if (phoneFollowUpList.Any())
                     {
-                        await _phoneFollowUpRepository.DeleteManyAsync(phoneFollowUpList);
+                        isDelete = false;
+                        phoneFollowUpList = phoneFollowUpList.Where(m => m.PlanFollowDate > DateTime.Now).ToList();
+                        if (phoneFollowUpList.Any())
+                        {
+                            await _phoneFollowUpRepository.DeleteManyAsync(phoneFollowUpList);
+                        }
                     }
-                }
 
-                if (smsSendList.Any())
-                {
-                    isDelete = false;
-                    smsSendList = smsSendList.Where(m => m.PlanSendDate > DateTime.Now).ToList();
                     if (smsSendList.Any())
                     {
-                        await _smsSendRepository.DeleteManyAsync(smsSendList);
-                        //删除任务计划
-                        var patientRegisterEnt = await _patientRegisterRepository.FirstOrDefaultAsync(f => f.Id == input.PatientRegisterId);
-                        if (patientRegisterEnt != null)
+                        isDelete = false;
+                        smsSendList = smsSendList.Where(m => m.PlanSendDate > DateTime.Now).ToList();
+                        if (smsSendList.Any())
                         {
-                            await _smsSendAppService.DeleteCriticalSmsAsync(patientRegisterEnt, smsSendList.First().Content);
-                        }
+                            await _smsSendRepository.DeleteManyAsync(smsSendList);
+                            //删除任务计划
+                            var patientRegisterEnt = await _patientRegisterRepository.FirstOrDefaultAsync(f => f.Id == input.PatientRegisterId);
+                            if (patientRegisterEnt != null)
+                            {
+                                await _smsSendAppService.DeleteCriticalSmsAsync(patientRegisterEnt, smsSendList.First().Content);
+                            }
 
 
+                        }
+                    }
+                    if (isDelete)
+                    {
+                        await _followUpRepository.DeleteAsync(isFollowUp);
                     }
-                }
-                if (isDelete)
-                {
-                    await _followUpRepository.DeleteAsync(isFollowUp);
                 }
             }
         }
diff --git a/src/Shentun.Peis.Application/RegisterCheckItems/RegisterCheckItemAppService.cs b/src/Shentun.Peis.Application/RegisterCheckItems/RegisterCheckItemAppService.cs
index 0f4b796..c38a2a3 100644
--- a/src/Shentun.Peis.Application/RegisterCheckItems/RegisterCheckItemAppService.cs
+++ b/src/Shentun.Peis.Application/RegisterCheckItems/RegisterCheckItemAppService.cs
@@ -409,7 +409,7 @@ namespace Shentun.Peis.RegisterCheckItems
             }
 
 
-         
+
             if (input.IsCriticalValue == 'Y' && registerCheckItemEnt.CriticalValueCreatorId == null)
             {
                 registerCheckItemEnt.CriticalValueCreatorId = _currentUser.Id;
@@ -444,11 +444,20 @@ namespace Shentun.Peis.RegisterCheckItems
                 }
                 else
                 {
-                    //删除随访表记录
-                    await _followUpAppService.DeleteByPatientRegisterId(new PatientRegisterIdInputDto
+                    var registerCheckItemCount = await _registerCheckItemRepository.CountAsync(c => c.RegisterCheckId == input.RegisterCheckId && (c.IsFollowUp == 'Y' || c.IsCriticalValue == 'Y'));
+                    if (registerCheckItemCount == 0)
                     {
-                        PatientRegisterId = registerCheckEnt.PatientRegisterId
-                    });
+                        //更新registerCheck
+                        registerCheckEnt.IsCriticalValue = registerCheckItemEnt.IsCriticalValue;
+                        registerCheckEnt.IsFollowUp= registerCheckItemEnt.IsFollowUp;
+                        await _registerCheckRepository.UpdateAsync(registerCheckEnt);
+
+                        //删除随访表记录  
+                        await _followUpAppService.DeleteByPatientRegisterId(new PatientRegisterIdInputDto
+                        {
+                            PatientRegisterId = registerCheckEnt.PatientRegisterId
+                        });
+                    }
                 }
 
             }
diff --git a/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs b/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs
index d282910..4c36fac 100644
--- a/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs
+++ b/src/Shentun.Peis.Application/RegisterChecks/RegisterCheckAppService.cs
@@ -736,6 +736,18 @@ namespace Shentun.Peis.RegisterChecks
             }
             else
             {
+
+                #region 更新明细项目的危急值跟随访值状态
+                var registerCheckItemList = await _registerCheckItemRepository.GetListAsync(m => m.RegisterCheckId == input.RegisterCheckId);
+                foreach (var registerCheckItem in registerCheckItemList)
+                {
+                    registerCheckItem.IsCriticalValue = registerCheckEnt.IsCriticalValue;
+                    registerCheckItem.IsFollowUp = registerCheckEnt.IsFollowUp;
+                }
+
+                await _registerCheckItemRepository.UpdateManyAsync(registerCheckItemList); 
+                #endregion
+
                 //删除随访表记录
                 await _followUpAppService.DeleteByPatientRegisterId(new PatientRegisterIdInputDto
                 {