diff --git a/sql-scripts/2025-01-11-add-reminder-sent-to-medication-records.sql b/sql-scripts/2025-01-11-add-reminder-sent-to-medication-records.sql
new file mode 100644
index 0000000..f16e249
--- /dev/null
+++ b/sql-scripts/2025-01-11-add-reminder-sent-to-medication-records.sql
@@ -0,0 +1,11 @@
+-- 为 t_medication_records 表添加 reminder_sent 字段
+-- 用于标记该条服药记录是否已经发送了提醒通知
+
+ALTER TABLE `t_medication_records`
+ADD COLUMN `reminder_sent` TINYINT(1) NOT NULL DEFAULT 0 COMMENT '是否已发送提醒' AFTER `deleted`;
+
+-- 为已存在的记录设置默认值
+UPDATE `t_medication_records` SET `reminder_sent` = 0 WHERE `reminder_sent` IS NULL;
+
+-- 添加索引以优化查询性能（查询未发送提醒的记录）
+CREATE INDEX `idx_reminder_sent_status_scheduled` ON `t_medication_records` (`reminder_sent`, `status`, `scheduled_time`);
\ No newline at end of file
diff --git a/src/medications/models/medication-record.model.ts b/src/medications/models/medication-record.model.ts
index 4ac7ca5..5f4d5fa 100644
--- a/src/medications/models/medication-record.model.ts
+++ b/src/medications/models/medication-record.model.ts
@@ -83,6 +83,14 @@ export class MedicationRecord extends Model {
   })
   declare deleted: boolean;
 
+  @Column({
+    type: DataType.BOOLEAN,
+    allowNull: false,
+    defaultValue: false,
+    comment: '是否已发送提醒',
+  })
+  declare reminderSent: boolean;
+
   // 关联关系
   @BelongsTo(() => Medication, 'medicationId')
   declare medication: Medication;
diff --git a/src/medications/services/medication-reminder.service.ts b/src/medications/services/medication-reminder.service.ts
index c3fd1b5..16cebb7 100644
--- a/src/medications/services/medication-reminder.service.ts
+++ b/src/medications/services/medication-reminder.service.ts
@@ -1,4 +1,5 @@
 import { Injectable, Logger } from '@nestjs/common';
+import { ConfigService } from '@nestjs/config';
 import { Cron } from '@nestjs/schedule';
 import { InjectModel } from '@nestjs/sequelize';
 import { Medication } from '../models/medication.model';
@@ -23,30 +24,42 @@ export class MedicationReminderService {
     @InjectModel(MedicationRecord)
     private readonly recordModel: typeof MedicationRecord,
     private readonly pushService: PushNotificationsService,
+    private readonly configService: ConfigService,
   ) {}
 
   /**
-   * 每5分钟检查一次需要发送的提醒
+   * 每1分钟检查一次需要发送的提醒
+   * 只有主进程（NODE_APP_INSTANCE=0）执行，避免多进程重复发送
    */
-  @Cron('*/5 * * * *')
+  @Cron('*/1 * * * *')
   async checkAndSendReminders(): Promise<void> {
     this.logger.log('开始检查服药提醒');
 
     try {
+      // 检查是否为主进程（NODE_APP_INSTANCE 为 0）
+      const nodeAppInstance = this.configService.get<number>('NODE_APP_INSTANCE', 0);
+      if (Number(nodeAppInstance) !== 0) {
+        this.logger.debug(`不是主进程 (instance: ${nodeAppInstance})，跳过服药提醒检查`);
+        return;
+      }
+
+      this.logger.log('主进程检测到，执行服药提醒检查...');
+
       // 计算时间范围：当前时间 + 15分钟
       const now = new Date();
       const reminderTime = dayjs(now)
         .add(this.REMINDER_MINUTES_BEFORE, 'minute')
         .toDate();
 
-      // 查找在接下来15分钟内需要提醒的记录
+      // 查找在接下来1分钟内需要提醒的记录
       const startRange = now;
-      const endRange = dayjs(now).add(5, 'minute').toDate(); // 5分钟窗口期
+      const endRange = dayjs(now).add(1, 'minute').toDate(); // 1分钟窗口期
 
       const upcomingRecords = await this.recordModel.findAll({
         where: {
           status: MedicationStatusEnum.UPCOMING,
           deleted: false,
+          reminderSent: false, // 只查询未发送提醒的记录
           scheduledTime: {
             [Op.between]: [
               dayjs(startRange).add(this.REMINDER_MINUTES_BEFORE, 'minute').toDate(),
@@ -84,11 +97,21 @@ export class MedicationReminderService {
       }
 
       // 为每个用户发送提醒
+      let successCount = 0;
+      let failedCount = 0;
+
       for (const [userId, records] of userRecordsMap.entries()) {
-        await this.sendReminderToUser(userId, records);
+        const success = await this.sendReminderToUser(userId, records);
+        if (success) {
+          successCount += records.length;
+          // 标记这些记录已发送提醒
+          await this.markRecordsAsReminded(records.map(r => r.id));
+        } else {
+          failedCount += records.length;
+        }
       }
 
-      this.logger.log(`成功发送 ${upcomingRecords.length} 条服药提醒`);
+      this.logger.log(`服药提醒发送完成 - 成功: ${successCount}, 失败: ${failedCount}`);
     } catch (error) {
       this.logger.error('检查服药提醒失败', error.stack);
     }
@@ -96,11 +119,12 @@ export class MedicationReminderService {
 
   /**
    * 为单个用户发送提醒
+   * @returns 是否发送成功
    */
   private async sendReminderToUser(
     userId: string,
     records: MedicationRecord[],
-  ): Promise<void> {
+  ): Promise<boolean> {
     try {
       const medicationNames = records
         .map((r) => r.medication?.name)
@@ -127,11 +151,34 @@ export class MedicationReminderService {
       });
 
       this.logger.log(`成功向用户 ${userId} 发送服药提醒`);
+      return true;
     } catch (error) {
       this.logger.error(
         `向用户 ${userId} 发送服药提醒失败`,
         error.stack,
       );
+      return false;
+    }
+  }
+
+  /**
+   * 标记记录为已发送提醒
+   */
+  private async markRecordsAsReminded(recordIds: string[]): Promise<void> {
+    try {
+      await this.recordModel.update(
+        { reminderSent: true },
+        {
+          where: {
+            id: {
+              [Op.in]: recordIds,
+            },
+          },
+        },
+      );
+      this.logger.debug(`已标记 ${recordIds.length} 条记录为已提醒`);
+    } catch (error) {
+      this.logger.error('标记记录为已提醒失败', error.stack);
     }
   }