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);
 }