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.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);