feat: 应用内通知系统 + 结构化手术史/用药等相关改动

- 新增用户通知 outbox 流水线(EfUserNotificationPipeline)与后台投递 worker
- 通知中心页面及前端通知服务接入
- 健康指标异常、用药/运动提醒等事件统一产出站内通知
- 健康档案结构化手术史、用药提醒扫描、医生/用户端点等配套调整
- AppDbContext 注册通知相关实体

backend/src/Health.Application/AI/PatientContextService.cs

@@ -24,7 +24,10 @@ public sealed class PatientContextService(
         if (archive != null)
         {
             if (!string.IsNullOrEmpty(archive.Diagnosis)) sb.AppendLine($"诊断: {archive.Diagnosis}");
-            if (!string.IsNullOrEmpty(archive.SurgeryType)) sb.AppendLine($"手术: {archive.SurgeryType} ({archive.SurgeryDate})");
+            if (archive.Surgeries.Count > 0)
+                sb.AppendLine($"手术: {string.Join("；", archive.Surgeries.Select(s => $"{s.Type} ({s.Date})"))}");
+            else if (!string.IsNullOrEmpty(archive.SurgeryType))
+                sb.AppendLine($"手术: {archive.SurgeryType} ({archive.SurgeryDate})");
             if (archive.ChronicDiseases.Count > 0) sb.AppendLine($"慢病史: {string.Join(", ", archive.ChronicDiseases)}");
             if (!string.IsNullOrEmpty(archive.FamilyHistory)) sb.AppendLine($"家族病史: {archive.FamilyHistory}");
             if (archive.Allergies.Count > 0) sb.AppendLine($"过敏: {string.Join(", ", archive.Allergies)}");

backend/src/Health.Application/HealthArchives/HealthArchiveContracts.cs

@@ -2,12 +2,22 @@ using Health.Domain.Entities;
 
 namespace Health.Application.HealthArchives;
 
+public sealed record HealthArchiveSurgeryDto(
+    Guid Id,
+    string Type,
+    DateOnly? Date);
+
+public sealed record HealthArchiveSurgeryInput(
+    string Type,
+    DateOnly? Date);
+
 public sealed record HealthArchiveDto(
     Guid Id,
     Guid UserId,
     string? Diagnosis,
     string? SurgeryType,
     DateOnly? SurgeryDate,
+    IReadOnlyList<HealthArchiveSurgeryDto> Surgeries,
     IReadOnlyList<string> Allergies,
     IReadOnlyList<string> DietRestrictions,
     IReadOnlyList<string> ChronicDiseases,
@@ -21,7 +31,8 @@ public sealed record HealthArchiveUpdateRequest(
     IReadOnlyList<string>? Allergies,
     IReadOnlyList<string>? DietRestrictions,
     IReadOnlyList<string>? ChronicDiseases,
-    string? FamilyHistory);
+    string? FamilyHistory,
+    IReadOnlyList<HealthArchiveSurgeryInput>? Surgeries = null);
 
 public interface IHealthArchiveService
 {

backend/src/Health.Application/HealthArchives/HealthArchiveService.cs

@@ -42,7 +42,8 @@ public sealed class HealthArchiveService(IHealthArchiveRepository archives) : IH
             "update_diagnosis" => request with
             {
                 SurgeryType = null, SurgeryDate = null, Allergies = null,
-                DietRestrictions = null, ChronicDiseases = null, FamilyHistory = null
+                DietRestrictions = null, ChronicDiseases = null, FamilyHistory = null,
+                Surgeries = null
             },
             "update_surgery" => request with
             {
@@ -77,8 +78,41 @@ public sealed class HealthArchiveService(IHealthArchiveRepository archives) : IH
     private static void Apply(HealthArchive archive, HealthArchiveUpdateRequest request)
     {
         if (request.Diagnosis != null) archive.Diagnosis = request.Diagnosis;
-        if (request.SurgeryType != null) archive.SurgeryType = request.SurgeryType;
-        if (request.SurgeryDate.HasValue) archive.SurgeryDate = request.SurgeryDate.Value;
+        if (request.Surgeries != null)
+        {
+            archive.Surgeries.Clear();
+            var items = request.Surgeries
+                .Where(s => !string.IsNullOrWhiteSpace(s.Type))
+                .Select((s, index) => new HealthArchiveSurgery
+                {
+                    Id = Guid.NewGuid(),
+                    HealthArchiveId = archive.Id,
+                    Type = s.Type.Trim(),
+                    Date = s.Date,
+                    SortOrder = index,
+                })
+                .ToList();
+            foreach (var item in items) archive.Surgeries.Add(item);
+            SyncLegacySurgeryFields(archive);
+        }
+        else if (request.SurgeryType != null)
+        {
+            SeedLegacySurgeryIfNeeded(archive);
+            var type = request.SurgeryType.Trim();
+            if (type.Length > 0 && !archive.Surgeries.Any(s =>
+                    s.Type == type && s.Date == request.SurgeryDate))
+            {
+                archive.Surgeries.Add(new HealthArchiveSurgery
+                {
+                    Id = Guid.NewGuid(),
+                    HealthArchiveId = archive.Id,
+                    Type = type,
+                    Date = request.SurgeryDate,
+                    SortOrder = archive.Surgeries.Count,
+                });
+            }
+            SyncLegacySurgeryFields(archive);
+        }
         if (request.Allergies != null) archive.Allergies = request.Allergies.ToList();
         if (request.DietRestrictions != null) archive.DietRestrictions = request.DietRestrictions.ToList();
         if (request.ChronicDiseases != null) archive.ChronicDiseases = request.ChronicDiseases.ToList();
@@ -91,6 +125,7 @@ public sealed class HealthArchiveService(IHealthArchiveRepository archives) : IH
         archive.Diagnosis,
         archive.SurgeryType,
         SurgeryDate = archive.SurgeryDate?.ToString("yyyy-MM-dd"),
+        surgeries = archive.Surgeries.Select(s => new { s.Type, date = s.Date?.ToString("yyyy-MM-dd") }),
         archive.Allergies,
         archive.DietRestrictions,
         archive.ChronicDiseases,
@@ -103,9 +138,41 @@ public sealed class HealthArchiveService(IHealthArchiveRepository archives) : IH
         archive.Diagnosis,
         archive.SurgeryType,
         archive.SurgeryDate,
+        GetSurgeries(archive),
         archive.Allergies,
         archive.DietRestrictions,
         archive.ChronicDiseases,
         archive.FamilyHistory,
         archive.UpdatedAt);
+
+    private static IReadOnlyList<HealthArchiveSurgeryDto> GetSurgeries(HealthArchive archive)
+    {
+        var surgeries = archive.Surgeries
+            .OrderBy(s => s.SortOrder)
+            .Select(s => new HealthArchiveSurgeryDto(s.Id, s.Type, s.Date))
+            .ToList();
+        if (surgeries.Count == 0 && !string.IsNullOrWhiteSpace(archive.SurgeryType))
+            surgeries.Add(new HealthArchiveSurgeryDto(Guid.Empty, archive.SurgeryType, archive.SurgeryDate));
+        return surgeries;
+    }
+
+    private static void SyncLegacySurgeryFields(HealthArchive archive)
+    {
+        var first = archive.Surgeries.OrderBy(s => s.SortOrder).FirstOrDefault();
+        archive.SurgeryType = first?.Type;
+        archive.SurgeryDate = first?.Date;
+    }
+
+    private static void SeedLegacySurgeryIfNeeded(HealthArchive archive)
+    {
+        if (archive.Surgeries.Count > 0 || string.IsNullOrWhiteSpace(archive.SurgeryType)) return;
+        archive.Surgeries.Add(new HealthArchiveSurgery
+        {
+            Id = Guid.NewGuid(),
+            HealthArchiveId = archive.Id,
+            Type = archive.SurgeryType,
+            Date = archive.SurgeryDate,
+            SortOrder = 0,
+        });
+    }
 }

backend/src/Health.Application/Medications/MedicationContracts.cs

@@ -78,7 +78,6 @@ public interface IMedicationRepository
     Task<bool> DoseLogExistsAsync(Guid userId, Guid medicationId, TimeOnly scheduledTime, DateTime startUtc, DateTime endUtc, CancellationToken ct);
     Task<MedicationLog?> GetDoseLogAsync(Guid userId, Guid medicationId, TimeOnly scheduledTime, DateTime startUtc, DateTime endUtc, CancellationToken ct);
     Task<IReadOnlyList<Medication>> ListActiveForReminderScanAsync(CancellationToken ct);
-    Task<bool> HasTakenInWindowAsync(Guid userId, Guid medicationId, DateTime startUtc, DateTime endUtc, CancellationToken ct);
     Task AddMedicationAsync(Medication medication, CancellationToken ct);
     Task AddLogAsync(MedicationLog log, CancellationToken ct);
     void DeleteMedication(Medication medication);

backend/src/Health.Application/Medications/MedicationReminderScanner.cs

@@ -21,10 +21,18 @@ public sealed class MedicationReminderScanner(IMedicationRepository medications)
         foreach (var medication in active)
         {
             if (!IsActiveOn(medication, date) || !GetDosesForToday(medication, date)) continue;
-            if (await _medications.HasTakenInWindowAsync(medication.UserId, medication.Id, todayStartUtc, todayEndUtc, ct)) continue;
 
             foreach (var scheduledTime in medication.TimeOfDay.Where(t => IsInWindow(t, windowStart, time)))
             {
+                if (await _medications.DoseLogExistsAsync(
+                    medication.UserId,
+                    medication.Id,
+                    scheduledTime,
+                    todayStartUtc,
+                    todayEndUtc,
+                    ct))
+                    continue;
+
                 tasks.Add(new MedicationReminderTask(
                     Guid.NewGuid(),
                     medication.UserId,

backend/src/Health.Application/Notifications/InAppNotificationContracts.cs

@@ -5,22 +5,56 @@ public sealed record InAppNotificationDto(
     string Type,
     string Title,
     string Message,
+    string Severity,
+    string? ActionType,
+    string? ActionTargetId,
+    bool IsRead,
     DateTime CreatedAt);
 
+public sealed record NotificationMessage(
+    string Type,
+    string Title,
+    string Message,
+    string Severity,
+    string? ActionType,
+    string? ActionTargetId);
+
 public interface IInAppNotificationService
 {
     Task<IReadOnlyList<InAppNotificationDto>> GetPendingAsync(Guid userId, CancellationToken ct);
+    Task<IReadOnlyList<InAppNotificationDto>> GetHistoryAsync(Guid userId, CancellationToken ct);
     Task<bool> AcknowledgeAsync(Guid userId, Guid notificationId, CancellationToken ct);
+    Task<int> MarkAllReadAsync(Guid userId, CancellationToken ct);
+    Task<bool> DeleteAsync(Guid userId, Guid notificationId, CancellationToken ct);
 }
 
 public interface IInAppNotificationRepository
 {
     Task<IReadOnlyList<InAppNotificationRecord>> GetPendingAsync(Guid userId, CancellationToken ct);
+    Task<IReadOnlyList<InAppNotificationRecord>> GetHistoryAsync(Guid userId, CancellationToken ct);
     Task<bool> AcknowledgeAsync(Guid userId, Guid notificationId, CancellationToken ct);
+    Task<int> MarkAllReadAsync(Guid userId, CancellationToken ct);
+    Task<bool> DeleteAsync(Guid userId, Guid notificationId, CancellationToken ct);
 }
 
 public sealed record InAppNotificationRecord(
     Guid Id,
     string Type,
-    string Payload,
+    string Title,
+    string Message,
+    string Severity,
+    string? ActionType,
+    string? ActionTargetId,
+    bool IsRead,
     DateTime CreatedAt);
+
+public interface IUserNotificationProducer
+{
+    Task<bool> EnqueueAsync(Guid userId, Guid sourceId, NotificationMessage message, CancellationToken ct);
+}
+
+public interface INotificationOutboxProcessor
+{
+    Task RecoverStaleAsync(CancellationToken ct);
+    Task<bool> ProcessNextAsync(CancellationToken ct);
+}

backend/src/Health.Application/Notifications/InAppNotificationService.cs

@@ -1,5 +1,3 @@
-using System.Text.Json;
-
 namespace Health.Application.Notifications;
 
 public sealed class InAppNotificationService(IInAppNotificationRepository notifications) : IInAppNotificationService
@@ -12,36 +10,22 @@ public sealed class InAppNotificationService(IInAppNotificationRepository notifi
         return records.Select(ToDto).ToList();
     }
 
+    public async Task<IReadOnlyList<InAppNotificationDto>> GetHistoryAsync(Guid userId, CancellationToken ct)
+    {
+        var records = await _notifications.GetHistoryAsync(userId, ct);
+        return records.Select(ToDto).ToList();
+    }
+
     public Task<bool> AcknowledgeAsync(Guid userId, Guid notificationId, CancellationToken ct) =>
         _notifications.AcknowledgeAsync(userId, notificationId, ct);
 
-    private static InAppNotificationDto ToDto(InAppNotificationRecord record)
-    {
-        if (record.Type == "MedicationReminder")
-        {
-            using var json = JsonDocument.Parse(record.Payload);
-            var root = json.RootElement;
-            var name = root.TryGetProperty("Name", out var nameValue) ? nameValue.GetString() : null;
-            var dosage = root.TryGetProperty("Dosage", out var dosageValue) ? dosageValue.GetString() : null;
-            var time = root.TryGetProperty("ScheduledTime", out var timeValue) ? timeValue.GetString() : null;
-            var details = string.Join(" · ", new[] { dosage, time }.Where(x => !string.IsNullOrWhiteSpace(x)));
-            return new InAppNotificationDto(
-                record.Id,
-                record.Type,
-                "用药提醒",
-                $"该服用{name ?? "药物"}{(details.Length > 0 ? $"（{details}）" : "")}了",
-                record.CreatedAt);
-        }
+    public Task<int> MarkAllReadAsync(Guid userId, CancellationToken ct) =>
+        _notifications.MarkAllReadAsync(userId, ct);
 
-        if (record.Type == "ExerciseReminder")
-        {
-            using var json = JsonDocument.Parse(record.Payload);
-            var root = json.RootElement;
-            var type = root.TryGetProperty("ExerciseType", out var typeValue) ? typeValue.GetString() : "运动";
-            var minutes = root.TryGetProperty("DurationMinutes", out var minutesValue) ? minutesValue.GetInt32() : 30;
-            return new InAppNotificationDto(record.Id, record.Type, "运动提醒", $"今天的{type}计划还未完成，目标 {minutes} 分钟", record.CreatedAt);
-        }
+    public Task<bool> DeleteAsync(Guid userId, Guid notificationId, CancellationToken ct) =>
+        _notifications.DeleteAsync(userId, notificationId, ct);
 
-        return new InAppNotificationDto(record.Id, record.Type, "健康提醒", "您有一条新的健康提醒", record.CreatedAt);
-    }
+    private static InAppNotificationDto ToDto(InAppNotificationRecord record) => new(
+        record.Id, record.Type, record.Title, record.Message, record.Severity,
+        record.ActionType, record.ActionTargetId, record.IsRead, record.CreatedAt);
 }

backend/src/Health.Domain/Entities/support_entities.cs

@@ -38,6 +38,18 @@ public sealed class HealthArchive
     public DateTime UpdatedAt { get; set; } = DateTime.UtcNow;
 
     public User User { get; set; } = null!;
+    public ICollection<HealthArchiveSurgery> Surgeries { get; set; } = [];
+}
+
+public sealed class HealthArchiveSurgery
+{
+    public Guid Id { get; set; }
+    public Guid HealthArchiveId { get; set; }
+    public string Type { get; set; } = string.Empty;
+    public DateOnly? Date { get; set; }
+    public int SortOrder { get; set; }
+
+    public HealthArchive HealthArchive { get; set; } = null!;
 }
 
 /// <summary>
@@ -97,3 +109,20 @@ public sealed class DeviceToken
 
     public User User { get; set; } = null!;
 }
+
+public sealed class UserNotification
+{
+    public Guid Id { get; set; }
+    public Guid UserId { get; set; }
+    public Guid SourceId { get; set; }
+    public string Type { get; set; } = string.Empty;
+    public string Title { get; set; } = string.Empty;
+    public string Message { get; set; } = string.Empty;
+    public string Severity { get; set; } = "info";
+    public string? ActionType { get; set; }
+    public string? ActionTargetId { get; set; }
+    public bool IsRead { get; set; }
+    public DateTime? ReadAt { get; set; }
+    public bool IsDeleted { get; set; }
+    public DateTime CreatedAt { get; set; } = DateTime.UtcNow;
+}

backend/src/Health.Infrastructure/AI/AgentHandlers/common_agent_handler.cs

@@ -55,7 +55,7 @@ public static class CommonAgentHandler
         return new
         {
             found = true, archive.Diagnosis, archive.SurgeryType,
-            SurgeryDate = archive.SurgeryDate?.ToString("yyyy-MM-dd"),
+            SurgeryDate = archive.SurgeryDate?.ToString("yyyy-MM-dd"), archive.Surgeries,
             archive.Allergies, archive.DietRestrictions, archive.ChronicDiseases, archive.FamilyHistory,
         };
     }

backend/src/Health.Infrastructure/Data/app_db_context.cs

@@ -28,11 +28,13 @@ public sealed class AppDbContext(DbContextOptions<AppDbContext> options) : DbCon
     public DbSet<DoctorProfile> DoctorProfiles => Set<DoctorProfile>();
     public DbSet<FollowUp> FollowUps => Set<FollowUp>();
     public DbSet<HealthArchive> HealthArchives => Set<HealthArchive>();
+    public DbSet<HealthArchiveSurgery> HealthArchiveSurgeries => Set<HealthArchiveSurgery>();
 
     // 支撑表
     public DbSet<RefreshToken> RefreshTokens => Set<RefreshToken>();
     public DbSet<VerificationCode> VerificationCodes => Set<VerificationCode>();
     public DbSet<NotificationPreference> NotificationPreferences => Set<NotificationPreference>();
+    public DbSet<UserNotification> UserNotifications => Set<UserNotification>();
     public DbSet<DeviceToken> DeviceTokens => Set<DeviceToken>();
     public DbSet<AiWriteCommandRecord> AiWriteCommands => Set<AiWriteCommandRecord>();
     public DbSet<ReportAnalysisTaskRecord> ReportAnalysisTasks => Set<ReportAnalysisTaskRecord>();
@@ -154,12 +156,33 @@ public sealed class AppDbContext(DbContextOptions<AppDbContext> options) : DbCon
             e.HasIndex(n => n.UserId).IsUnique();
         });
 
+        builder.Entity<UserNotification>(e =>
+        {
+            e.ToTable("UserNotifications");
+            e.HasIndex(n => n.SourceId).IsUnique();
+            e.HasIndex(n => new { n.UserId, n.IsDeleted, n.IsRead, n.CreatedAt });
+            e.Property(n => n.Type).HasMaxLength(64);
+            e.Property(n => n.Severity).HasMaxLength(16);
+            e.Property(n => n.ActionType).HasMaxLength(64);
+        });
+
         // ---- HealthArchive ----
         builder.Entity<HealthArchive>(e =>
         {
             e.HasIndex(a => a.UserId).IsUnique();
         });
 
+        builder.Entity<HealthArchiveSurgery>(e =>
+        {
+            e.ToTable("HealthArchiveSurgeries");
+            e.HasIndex(s => new { s.HealthArchiveId, s.SortOrder });
+            e.Property(s => s.Type).HasMaxLength(256);
+            e.HasOne(s => s.HealthArchive)
+                .WithMany(a => a.Surgeries)
+                .HasForeignKey(s => s.HealthArchiveId)
+                .OnDelete(DeleteBehavior.Cascade);
+        });
+
         builder.Entity<AiWriteCommandRecord>(e =>
         {
             e.ToTable("AiWriteCommands");

backend/src/Health.Infrastructure/Exercises/ExerciseReminderProducer.cs

@@ -1,12 +1,13 @@
 using System.Text.Json;
 using Health.Application.Exercises;
-using Health.Infrastructure.Data.Records;
+using Health.Application.Notifications;
 
 namespace Health.Infrastructure.Exercises;
 
-public sealed class ExerciseReminderProducer(AppDbContext db) : IExerciseReminderProducer
+public sealed class ExerciseReminderProducer(AppDbContext db, IUserNotificationProducer notifications) : IExerciseReminderProducer
 {
     private readonly AppDbContext _db = db;
+    private readonly IUserNotificationProducer _notifications = notifications;
 
     public async Task<int> ProduceDueAsync(DateTime utcNow, CancellationToken ct)
     {
@@ -17,28 +18,22 @@ public sealed class ExerciseReminderProducer(AppDbContext db) : IExerciseReminde
             .Include(x => x.Plan)
             .Where(x => x.ScheduledDate == today && !x.IsCompleted && !x.IsRestDay && x.Plan.ReminderTime <= currentTime)
             .ToListAsync(ct);
-        var sourceIds = dueItems.Select(x => x.Id).ToList();
-        var existing = await _db.NotificationOutbox.AsNoTracking()
-            .Where(x => sourceIds.Contains(x.SourceTaskId))
-            .Select(x => x.SourceTaskId)
-            .ToListAsync(ct);
-        var existingSet = existing.ToHashSet();
-        var now = DateTime.UtcNow;
-        foreach (var item in dueItems.Where(x => !existingSet.Contains(x.Id)))
+        var created = 0;
+        foreach (var item in dueItems)
         {
-            await _db.NotificationOutbox.AddAsync(new NotificationOutboxRecord
-            {
-                Id = Guid.NewGuid(), UserId = item.Plan.UserId, SourceTaskId = item.Id,
-                Type = "ExerciseReminder",
-                Payload = JsonSerializer.Serialize(new
-                {
-                    item.ExerciseType, item.DurationMinutes, item.ScheduledDate,
-                    ReminderTime = item.Plan.ReminderTime,
-                }),
-                Status = "AwaitingProvider", AvailableAt = now, CreatedAt = now, UpdatedAt = now,
-            }, ct);
+            if (await _notifications.EnqueueAsync(
+                item.Plan.UserId,
+                item.Id,
+                new NotificationMessage(
+                    "ExerciseReminder",
+                    "今日运动计划",
+                    $"今天安排了 {item.ExerciseType} {item.DurationMinutes} 分钟，完成后记得打卡。",
+                    "info",
+                    "exercise",
+                    item.PlanId.ToString()),
+                ct))
+                created++;
         }
-        if (_db.ChangeTracker.HasChanges()) await _db.SaveChangesAsync(ct);
-        return dueItems.Count - existingSet.Count;
+        return created;
     }
 }

backend/src/Health.Infrastructure/HealthArchives/EfHealthArchiveRepository.cs

@@ -7,7 +7,9 @@ public sealed class EfHealthArchiveRepository(AppDbContext db) : IHealthArchiveR
     private readonly AppDbContext _db = db;
 
     public Task<HealthArchive?> GetByUserIdAsync(Guid userId, CancellationToken ct) =>
-        _db.HealthArchives.FirstOrDefaultAsync(a => a.UserId == userId, ct);
+        _db.HealthArchives
+            .Include(a => a.Surgeries)
+            .FirstOrDefaultAsync(a => a.UserId == userId, ct);
 
     public async Task AddAsync(HealthArchive archive, CancellationToken ct) =>
         await _db.HealthArchives.AddAsync(archive, ct);

backend/src/Health.Infrastructure/Medications/EfMedicationRepository.cs

@@ -56,12 +56,6 @@ public sealed class EfMedicationRepository(AppDbContext db) : IMedicationReposit
             .Where(m => m.IsActive && m.TimeOfDay.Count > 0)
             .ToListAsync(ct);
 
-    public Task<bool> HasTakenInWindowAsync(Guid userId, Guid medicationId, DateTime startUtc, DateTime endUtc, CancellationToken ct) =>
-        _db.MedicationLogs.AnyAsync(l =>
-            l.UserId == userId && l.MedicationId == medicationId
-            && l.CreatedAt >= startUtc && l.CreatedAt < endUtc
-            && l.Status == MedicationLogStatus.Taken, ct);
-
     public async Task AddMedicationAsync(Medication medication, CancellationToken ct) =>
         await _db.Medications.AddAsync(medication, ct);
 

backend/src/Health.Infrastructure/Medications/OutboxMedicationReminderDispatcher.cs

@@ -1,43 +1,35 @@
 using System.Text.Json;
 using Health.Application.Medications;
-using Health.Infrastructure.Data.Records;
+using Health.Application.Notifications;
 using Microsoft.Extensions.Logging;
 
 namespace Health.Infrastructure.Medications;
 
 public sealed class OutboxMedicationReminderDispatcher(
-    AppDbContext db,
+    IUserNotificationProducer notifications,
     ILogger<OutboxMedicationReminderDispatcher> logger) : IMedicationReminderDispatcher
 {
-    private readonly AppDbContext _db = db;
+    private readonly IUserNotificationProducer _notifications = notifications;
     private readonly ILogger<OutboxMedicationReminderDispatcher> _logger = logger;
 
     public async Task DispatchAsync(MedicationReminderTask task, CancellationToken ct)
     {
-        if (await _db.NotificationOutbox.AsNoTracking().AnyAsync(x => x.SourceTaskId == task.TaskId, ct))
-            return;
-
-        var now = DateTime.UtcNow;
-        await _db.NotificationOutbox.AddAsync(new NotificationOutboxRecord
+        var details = string.Join(" · ", new[]
         {
-            Id = Guid.NewGuid(),
-            UserId = task.UserId,
-            SourceTaskId = task.TaskId,
-            Type = "MedicationReminder",
-            Payload = JsonSerializer.Serialize(new
-            {
-                task.MedicationId,
-                task.Name,
-                task.Dosage,
-                task.ScheduledDate,
-                task.ScheduledTime,
-            }),
-            Status = "AwaitingProvider",
-            AvailableAt = now,
-            CreatedAt = now,
-            UpdatedAt = now,
-        }, ct);
-        await _db.SaveChangesAsync(ct);
+            task.Dosage,
+            task.ScheduledTime.ToString("HH:mm")
+        }.Where(x => !string.IsNullOrWhiteSpace(x)));
+        await _notifications.EnqueueAsync(
+            task.UserId,
+            task.TaskId,
+            new NotificationMessage(
+                "MedicationReminder",
+                "用药时间到了",
+                $"请按计划服用{task.Name}{(details.Length > 0 ? $"（{details}）" : "")}，服用后记得打卡。",
+                "info",
+                "medication",
+                task.MedicationId.ToString()),
+            ct);
 
         _logger.LogInformation(
             "用药提醒已写入通知 Outbox，等待推送服务: {TaskId} {UserId}",

backend/src/Health.Infrastructure/Notifications/EfInAppNotificationRepository.cs

@@ -7,20 +7,46 @@ public sealed class EfInAppNotificationRepository(AppDbContext db) : IInAppNotif
     private readonly AppDbContext _db = db;
 
     public async Task<IReadOnlyList<InAppNotificationRecord>> GetPendingAsync(Guid userId, CancellationToken ct) =>
-        await _db.NotificationOutbox.AsNoTracking()
-            .Where(x => x.UserId == userId && x.Status == "AwaitingProvider")
+        await _db.UserNotifications.AsNoTracking()
+            .Where(x => x.UserId == userId && !x.IsRead && !x.IsDeleted)
             .OrderBy(x => x.CreatedAt)
             .Take(10)
-            .Select(x => new InAppNotificationRecord(x.Id, x.Type, x.Payload, x.CreatedAt))
+            .Select(x => new InAppNotificationRecord(x.Id, x.Type, x.Title, x.Message,
+                x.Severity, x.ActionType, x.ActionTargetId, x.IsRead, x.CreatedAt))
+            .ToListAsync(ct);
+
+    public async Task<IReadOnlyList<InAppNotificationRecord>> GetHistoryAsync(Guid userId, CancellationToken ct) =>
+        await _db.UserNotifications.AsNoTracking()
+            .Where(x => x.UserId == userId && !x.IsDeleted)
+            .OrderByDescending(x => x.CreatedAt)
+            .Take(100)
+            .Select(x => new InAppNotificationRecord(x.Id, x.Type, x.Title, x.Message,
+                x.Severity, x.ActionType, x.ActionTargetId, x.IsRead, x.CreatedAt))
             .ToListAsync(ct);
 
     public async Task<bool> AcknowledgeAsync(Guid userId, Guid notificationId, CancellationToken ct)
     {
-        var updated = await _db.NotificationOutbox
-            .Where(x => x.Id == notificationId && x.UserId == userId && x.Status == "AwaitingProvider")
+        var updated = await _db.UserNotifications
+            .Where(x => x.Id == notificationId && x.UserId == userId && !x.IsRead && !x.IsDeleted)
             .ExecuteUpdateAsync(setters => setters
-                .SetProperty(x => x.Status, "InAppDelivered")
-                .SetProperty(x => x.UpdatedAt, DateTime.UtcNow), ct);
+                .SetProperty(x => x.IsRead, true)
+                .SetProperty(x => x.ReadAt, DateTime.UtcNow), ct);
         return updated > 0;
     }
+
+    public Task<int> MarkAllReadAsync(Guid userId, CancellationToken ct) =>
+        _db.UserNotifications
+            .Where(x => x.UserId == userId && !x.IsRead && !x.IsDeleted)
+            .ExecuteUpdateAsync(setters => setters
+                .SetProperty(x => x.IsRead, true)
+                .SetProperty(x => x.ReadAt, DateTime.UtcNow), ct);
+
+    public async Task<bool> DeleteAsync(Guid userId, Guid notificationId, CancellationToken ct)
+    {
+        var deleted = await _db.UserNotifications
+            .Where(x => x.Id == notificationId && x.UserId == userId && !x.IsDeleted)
+            .ExecuteUpdateAsync(setters => setters
+                .SetProperty(x => x.IsDeleted, true), ct);
+        return deleted > 0;
+    }
 }

backend/src/Health.Infrastructure/Notifications/EfUserNotificationPipeline.cs

@@ -0,0 +1,139 @@
+using System.Text.Json;
+using Health.Application.Notifications;
+using Health.Infrastructure.Data.Records;
+using Npgsql;
+
+namespace Health.Infrastructure.Notifications;
+
+public sealed class EfUserNotificationProducer(AppDbContext db) : IUserNotificationProducer
+{
+    private readonly AppDbContext _db = db;
+
+    public async Task<bool> EnqueueAsync(
+        Guid userId,
+        Guid sourceId,
+        NotificationMessage message,
+        CancellationToken ct)
+    {
+        if (await _db.NotificationOutbox.AsNoTracking().AnyAsync(x => x.SourceTaskId == sourceId, ct))
+            return false;
+
+        var now = DateTime.UtcNow;
+        await _db.NotificationOutbox.AddAsync(new NotificationOutboxRecord
+        {
+            Id = Guid.NewGuid(),
+            UserId = userId,
+            SourceTaskId = sourceId,
+            Type = message.Type,
+            Payload = JsonSerializer.Serialize(message),
+            Status = "Pending",
+            AvailableAt = now,
+            CreatedAt = now,
+            UpdatedAt = now,
+        }, ct);
+
+        try
+        {
+            await _db.SaveChangesAsync(ct);
+            return true;
+        }
+        catch (DbUpdateException ex) when (
+            ex.InnerException is PostgresException { SqlState: PostgresErrorCodes.UniqueViolation })
+        {
+            _db.ChangeTracker.Clear();
+            return false;
+        }
+    }
+}
+
+public sealed class EfNotificationOutboxProcessor(AppDbContext db) : INotificationOutboxProcessor
+{
+    private const int MaxAttempts = 5;
+    private readonly AppDbContext _db = db;
+
+    public async Task RecoverStaleAsync(CancellationToken ct)
+    {
+        var now = DateTime.UtcNow;
+        await _db.NotificationOutbox
+            .Where(x => x.Status == "Processing" &&
+                x.UpdatedAt < now.AddMinutes(-5) && x.Attempts < MaxAttempts)
+            .ExecuteUpdateAsync(setters => setters
+                .SetProperty(x => x.Status, "Pending")
+                .SetProperty(x => x.AvailableAt, now)
+                .SetProperty(x => x.UpdatedAt, now), ct);
+
+        await _db.NotificationOutbox
+            .Where(x => x.Status == "Processing" &&
+                x.UpdatedAt < now.AddMinutes(-5) && x.Attempts >= MaxAttempts)
+            .ExecuteUpdateAsync(setters => setters
+                .SetProperty(x => x.Status, "Failed")
+                .SetProperty(x => x.LastError, "通知任务执行超时且已达到最大重试次数")
+                .SetProperty(x => x.UpdatedAt, now), ct);
+    }
+
+    public async Task<bool> ProcessNextAsync(CancellationToken ct)
+    {
+        var now = DateTime.UtcNow;
+        var candidate = await _db.NotificationOutbox.AsNoTracking()
+            .Where(x => x.Status == "Pending" &&
+                x.AvailableAt <= now && x.Attempts < MaxAttempts)
+            .OrderBy(x => x.CreatedAt)
+            .FirstOrDefaultAsync(ct);
+        if (candidate == null) return false;
+
+        var claimed = await _db.NotificationOutbox
+            .Where(x => x.Id == candidate.Id && x.Status == "Pending")
+            .ExecuteUpdateAsync(setters => setters
+                .SetProperty(x => x.Status, "Processing")
+                .SetProperty(x => x.Attempts, x => x.Attempts + 1)
+                .SetProperty(x => x.UpdatedAt, now), ct);
+        if (claimed == 0) return true;
+
+        try
+        {
+            var message = JsonSerializer.Deserialize<NotificationMessage>(candidate.Payload)
+                ?? throw new InvalidOperationException("通知消息内容为空");
+
+            if (!await _db.UserNotifications.AsNoTracking()
+                    .AnyAsync(x => x.SourceId == candidate.SourceTaskId, ct))
+            {
+                await _db.UserNotifications.AddAsync(new UserNotification
+                {
+                    Id = Guid.NewGuid(),
+                    UserId = candidate.UserId,
+                    SourceId = candidate.SourceTaskId,
+                    Type = message.Type,
+                    Title = message.Title,
+                    Message = message.Message,
+                    Severity = message.Severity,
+                    ActionType = message.ActionType,
+                    ActionTargetId = message.ActionTargetId,
+                    CreatedAt = candidate.CreatedAt,
+                }, ct);
+                // Persist the inbox item first. If completion fails, stale-task
+                // recovery can safely retry because SourceId is idempotent.
+                await _db.SaveChangesAsync(ct);
+            }
+
+            await _db.NotificationOutbox.Where(x => x.Id == candidate.Id)
+                .ExecuteUpdateAsync(setters => setters
+                    .SetProperty(x => x.Status, "Completed")
+                    .SetProperty(x => x.LastError, (string?)null)
+                    .SetProperty(x => x.UpdatedAt, DateTime.UtcNow), ct);
+        }
+        catch (Exception ex)
+        {
+            var attempts = candidate.Attempts + 1;
+            await _db.NotificationOutbox.Where(x => x.Id == candidate.Id)
+                .ExecuteUpdateAsync(setters => setters
+                    .SetProperty(x => x.Status, attempts >= MaxAttempts ? "Failed" : "Pending")
+                    .SetProperty(x => x.AvailableAt,
+                        DateTime.UtcNow.AddSeconds(Math.Pow(2, attempts) * 5))
+                    .SetProperty(x => x.LastError,
+                        ex.Message.Length > 2000 ? ex.Message[..2000] : ex.Message)
+                    .SetProperty(x => x.UpdatedAt, DateTime.UtcNow), ct);
+        }
+
+        return true;
+    }
+}

backend/src/Health.Infrastructure/Users/EfUserRepository.cs

@@ -40,6 +40,8 @@ public sealed class EfUserRepository(AppDbContext db) : IUserRepository
         await _db.FollowUps.Where(f => f.UserId == userId).ExecuteDeleteAsync(ct);
         await _db.RefreshTokens.Where(t => t.UserId == userId).ExecuteDeleteAsync(ct);
         await _db.DeviceTokens.Where(t => t.UserId == userId).ExecuteDeleteAsync(ct);
+        await _db.UserNotifications.Where(n => n.UserId == userId).ExecuteDeleteAsync(ct);
+        await _db.NotificationOutbox.Where(n => n.UserId == userId).ExecuteDeleteAsync(ct);
         await _db.NotificationPreferences.Where(p => p.UserId == userId).ExecuteDeleteAsync(ct);
         await _db.HealthArchives.Where(a => a.UserId == userId).ExecuteDeleteAsync(ct);
         await _db.AiWriteCommands.Where(c => c.UserId == userId).ExecuteDeleteAsync(ct);

backend/src/Health.WebApi/BackgroundServices/notification_outbox_worker.cs

@@ -0,0 +1,37 @@
+using Health.Application.Notifications;
+
+namespace Health.WebApi.BackgroundServices;
+
+public sealed class NotificationOutboxWorker(
+    IServiceScopeFactory scopeFactory,
+    ILogger<NotificationOutboxWorker> logger) : BackgroundService
+{
+    protected override async Task ExecuteAsync(CancellationToken stoppingToken)
+    {
+        var nextRecovery = DateTime.MinValue;
+        while (!stoppingToken.IsCancellationRequested)
+        {
+            try
+            {
+                using var scope = scopeFactory.CreateScope();
+                var processor = scope.ServiceProvider.GetRequiredService<INotificationOutboxProcessor>();
+                if (DateTime.UtcNow >= nextRecovery)
+                {
+                    await processor.RecoverStaleAsync(stoppingToken);
+                    nextRecovery = DateTime.UtcNow.AddMinutes(1);
+                }
+                if (!await processor.ProcessNextAsync(stoppingToken))
+                    await Task.Delay(TimeSpan.FromSeconds(2), stoppingToken);
+            }
+            catch (OperationCanceledException) when (stoppingToken.IsCancellationRequested)
+            {
+                break;
+            }
+            catch (Exception ex)
+            {
+                logger.LogError(ex, "通知 Outbox 消费失败");
+                await Task.Delay(TimeSpan.FromSeconds(2), stoppingToken);
+            }
+        }
+    }
+}

backend/src/Health.WebApi/Endpoints/doctor_endpoints.cs

@@ -132,6 +132,7 @@ public static class DoctorEndpoints
 
             var user = await db.Users
                 .Include(u => u.HealthArchive)
+                .ThenInclude(a => a!.Surgeries)
                 .FirstOrDefaultAsync(u => u.Id == id && u.DoctorId == doctorId);
             if (user == null)
                 return Results.Ok(new { code = 404, data = (object?)null, message = "患者不存在" });
@@ -179,7 +180,18 @@ public static class DoctorEndpoints
                 data = new
                 {
                     profile = new { user.Id, user.Phone, user.Name, user.Gender, BirthDate = user.BirthDate?.ToString("yyyy-MM-dd"), user.AvatarUrl },
-                    archive = user.HealthArchive == null ? null : new { user.HealthArchive.Diagnosis, user.HealthArchive.SurgeryType, SurgeryDate = user.HealthArchive.SurgeryDate?.ToString("yyyy-MM-dd"), user.HealthArchive.Allergies, user.HealthArchive.DietRestrictions, user.HealthArchive.ChronicDiseases, user.HealthArchive.FamilyHistory },
+                    archive = user.HealthArchive == null ? null : new
+                    {
+                        user.HealthArchive.Diagnosis,
+                        user.HealthArchive.SurgeryType,
+                        SurgeryDate = user.HealthArchive.SurgeryDate?.ToString("yyyy-MM-dd"),
+                        surgeries = user.HealthArchive.Surgeries.OrderBy(s => s.SortOrder)
+                            .Select(s => new { s.Type, Date = s.Date.HasValue ? s.Date.Value.ToString("yyyy-MM-dd") : null }),
+                        user.HealthArchive.Allergies,
+                        user.HealthArchive.DietRestrictions,
+                        user.HealthArchive.ChronicDiseases,
+                        user.HealthArchive.FamilyHistory
+                    },
                     latestRecords,
                     trendRecords,
                     medications,

backend/src/Health.WebApi/Endpoints/notification_endpoints.cs

@@ -17,6 +17,19 @@ public static class NotificationEndpoints
             return Results.Ok(new { code = 0, data = result, message = (string?)null });
         });
 
+        group.MapGet("", async (HttpContext http, IInAppNotificationService notifications, CancellationToken ct) =>
+        {
+            var userId = GetUserId(http);
+            if (userId == Guid.Empty) return Results.Unauthorized();
+            var result = await notifications.GetHistoryAsync(userId, ct);
+            return Results.Ok(new
+            {
+                code = 0,
+                data = new { unreadCount = result.Count(x => !x.IsRead), items = result },
+                message = (string?)null
+            });
+        });
+
         group.MapPost("/{id:guid}/acknowledge", async (Guid id, HttpContext http, IInAppNotificationService notifications, CancellationToken ct) =>
         {
             var userId = GetUserId(http);
@@ -24,6 +37,25 @@ public static class NotificationEndpoints
             var acknowledged = await notifications.AcknowledgeAsync(userId, id, ct);
             return Results.Ok(new { code = 0, data = new { acknowledged }, message = (string?)null });
         });
+
+        group.MapPost("/read-all", async (HttpContext http, IInAppNotificationService notifications, CancellationToken ct) =>
+        {
+            var userId = GetUserId(http);
+            if (userId == Guid.Empty) return Results.Unauthorized();
+            var count = await notifications.MarkAllReadAsync(userId, ct);
+            return Results.Ok(new { code = 0, data = new { count }, message = (string?)null });
+        });
+
+
+        group.MapDelete("/{id:guid}", async (Guid id, HttpContext http, IInAppNotificationService notifications, CancellationToken ct) =>
+        {
+            var userId = GetUserId(http);
+            if (userId == Guid.Empty) return Results.Unauthorized();
+            var deleted = await notifications.DeleteAsync(userId, id, ct);
+            return deleted
+                ? Results.Ok(new { code = 0, data = new { deleted = true }, message = (string?)null })
+                : Results.NotFound(new { code = 404, data = (object?)null, message = "通知不存在" });
+        });
     }
 
     private static Guid GetUserId(HttpContext http) =>

backend/src/Health.WebApi/Endpoints/user_endpoints.cs

@@ -36,6 +36,9 @@ public static class UserEndpoints
         group.MapPut("/health-archive", async (UpdateArchiveRequest req, HttpContext http, IHealthArchiveService archives, CancellationToken ct) =>
         {
             var surgeryDate = DateOnly.TryParse(req.SurgeryDate, out var parsed) ? parsed : (DateOnly?)null;
+            var surgeries = req.Surgeries?.Select(s => new HealthArchiveSurgeryInput(
+                s.Type,
+                DateOnly.TryParse(s.Date, out var date) ? date : null)).ToList();
             await archives.UpdateAsync(
                 GetUserId(http),
                 new HealthArchiveUpdateRequest(
@@ -45,7 +48,8 @@ public static class UserEndpoints
                     req.Allergies,
                     req.DietRestrictions,
                     req.ChronicDiseases,
-                    req.FamilyHistory),
+                    req.FamilyHistory,
+                    surgeries),
                 ct);
             return Results.Ok(new { code = 0, data = new { success = true }, message = (string?)null });
         });
@@ -65,4 +69,7 @@ public sealed record UpdateProfileRequest(string? Name, string? Gender, string?
 public sealed record UpdateArchiveRequest(
     string? Diagnosis, string? SurgeryType, string? SurgeryDate,
     List<string>? Allergies, List<string>? DietRestrictions,
-    List<string>? ChronicDiseases, string? FamilyHistory);
+    List<string>? ChronicDiseases, string? FamilyHistory,
+    List<UpdateArchiveSurgeryRequest>? Surgeries);
+
+public sealed record UpdateArchiveSurgeryRequest(string Type, string? Date);