diff --git a/src/controller/admin/patient.js b/src/controller/admin/patient.js
index 17090d3..0d96aca 100644
--- a/src/controller/admin/patient.js
+++ b/src/controller/admin/patient.js
@@ -54,7 +54,7 @@ module.exports = class extends Base {
       item.region_name = [pName, cName, dName].filter(Boolean).join(' ');
     });
 
-    const counts = await model.getStatusCounts();
+    const counts = await model.getStatusCounts({ keyword, tag, startDate, endDate, province_code, city_code, district_code });
     return this.success({ ...list, counts });
   }
 
diff --git a/src/model/patient.js b/src/model/patient.js
index 1e2f06c..c8853d7 100644
--- a/src/model/patient.js
+++ b/src/model/patient.js
@@ -147,17 +147,17 @@ module.exports = class extends think.Model {
   }
 
   /**
-   * 获取各状态数量（单次查询）
+   * 获取各状态数量（支持筛选条件，排除 status）
    */
-  async getStatusCounts() {
-    const sql = `SELECT
-      COUNT(*) AS \`all\`,
-      SUM(status = -1) AS draft,
-      SUM(status = 0) AS pending,
-      SUM(status = 1) AS approved,
-      SUM(status = 2) AS rejected
-      FROM patient WHERE is_deleted = 0`;
-    const rows = await this.query(sql);
+  async getStatusCounts(filters = {}) {
+    // 复用 _buildWhere，但排除 status
+    const { status, ...rest } = filters;
+    const where = this._buildWhere(rest);
+    // 删掉 status 条件（_buildWhere 不会加，但保险起见）
+    delete where.status;
+    const rows = await this.where(where)
+      .field('COUNT(*) AS `all`, SUM(status = -1) AS draft, SUM(status = 0) AS pending, SUM(status = 1) AS approved, SUM(status = 2) AS rejected')
+      .select();
     const row = rows[0] || {};
     return {
       all: parseInt(row.all, 10) || 0,
diff --git a/view/admin/patient_index.html b/view/admin/patient_index.html
index 7b9e6cf..8c10272 100644
--- a/view/admin/patient_index.html
+++ b/view/admin/patient_index.html
@@ -98,10 +98,12 @@
     <div class="flex justify-end mt-4">
       <el-pagination
         v-model:current-page="pagination.page"
-        :page-size="pagination.pageSize"
+        v-model:page-size="pagination.pageSize"
+        :page-sizes="[10, 20, 50, 100]"
         :total="pagination.total"
-        layout="total, prev, pager, next"
+        layout="total, sizes, prev, pager, next"
         @current-change="loadList"
+        @size-change="onSizeChange"
       />
     </div>
   </el-card>
@@ -322,6 +324,11 @@ const app = createApp({
       loadList();
     }
 
+    function onSizeChange() {
+      pagination.page = 1;
+      loadList();
+    }
+
     function viewDetail(row) {
       if (!perms.canView) {
         ElementPlus.ElMessageBox.alert('暂无查看详情权限，请先联系管理员授权', '温馨提示', {
@@ -480,7 +487,7 @@ const app = createApp({
       keyword, dateRange, tagFilter, regionFilter, activeTab, loading, tableData, pagination, counts,
       uploadHeaders, addVisible, addSaving, addForm, exporting, editingId, perms,
       regionTree, tagOptions, Plus, Download,
-      loadList, resetFilter, onTabChange, viewDetail, showAddDialog, showEditDialog, handleExport,
+      loadList, resetFilter, onTabChange, onSizeChange, viewDetail, showAddDialog, showEditDialog, handleExport,
       onIdCardInput, onDocUpload, onSignUpload, submitAdd
     };
   }