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/tests/Health.Tests/persistence_pipeline_tests.cs

@@ -1,6 +1,11 @@
+using Health.Application.Medications;
+using Health.Domain.Entities;
+using Health.Domain.Enums;
 using Health.Infrastructure.AI;
 using Health.Infrastructure.Data;
 using Health.Infrastructure.Data.Records;
+using Health.Infrastructure.Medications;
+using Health.Infrastructure.Notifications;
 using Health.Infrastructure.Reports;
 using Microsoft.EntityFrameworkCore;
 
@@ -57,6 +62,112 @@ public sealed class PersistencePipelineTests
         Assert.Equal(2000, task.LastError!.Length);
     }
 
+    [Fact]
+    public async Task ReportTask_OnlyEnqueuesFailureNotificationAtFinalAttempt()
+    {
+        await using var db = CreateDbContext();
+        var userId = Guid.NewGuid();
+        var report = new Report
+        {
+            Id = Guid.NewGuid(),
+            UserId = userId,
+            FileUrl = "report.jpg",
+            Status = ReportStatus.Analyzing,
+        };
+        var task = NewReportTask(attempts: 2);
+        task.ReportId = report.Id;
+        db.Reports.Add(report);
+        db.ReportAnalysisTasks.Add(task);
+        await db.SaveChangesAsync();
+        var queue = new EfReportAnalysisQueue(db, new EfUserNotificationProducer(db));
+
+        await queue.RetryAsync(task.Id, "temporary failure", CancellationToken.None);
+        Assert.Empty(db.NotificationOutbox);
+
+        task.Status = "Processing";
+        task.Attempts = 3;
+        await db.SaveChangesAsync();
+        await queue.RetryAsync(task.Id, "final failure", CancellationToken.None);
+
+        var notification = Assert.Single(db.NotificationOutbox);
+        Assert.Equal(task.Id, notification.SourceTaskId);
+        Assert.Equal("ReportAnalysisFailed", notification.Type);
+        Assert.Equal(userId, notification.UserId);
+    }
+
+    [Fact]
+    public async Task MedicationReminder_MorningDoseDoesNotSuppressEveningDose()
+    {
+        await using var db = CreateDbContext();
+        var userId = Guid.NewGuid();
+        var medicationId = Guid.NewGuid();
+        var scanTimeUtc = new DateTime(2026, 6, 20, 12, 2, 0, DateTimeKind.Utc);
+        db.Medications.Add(new Medication
+        {
+            Id = medicationId,
+            UserId = userId,
+            Name = "测试药物",
+            Frequency = MedicationFrequency.TwiceDaily,
+            TimeOfDay = [new TimeOnly(8, 0), new TimeOnly(20, 0)],
+            StartDate = new DateOnly(2026, 6, 20),
+            IsActive = true,
+        });
+        db.MedicationLogs.Add(new MedicationLog
+        {
+            Id = Guid.NewGuid(),
+            UserId = userId,
+            MedicationId = medicationId,
+            Status = MedicationLogStatus.Taken,
+            ScheduledTime = new TimeOnly(8, 0),
+            ConfirmedAt = new DateTime(2026, 6, 20, 0, 1, 0, DateTimeKind.Utc),
+            CreatedAt = new DateTime(2026, 6, 20, 0, 1, 0, DateTimeKind.Utc),
+        });
+        await db.SaveChangesAsync();
+        var scanner = new MedicationReminderScanner(new EfMedicationRepository(db));
+
+        var tasks = await scanner.ScanAsync(scanTimeUtc, CancellationToken.None);
+
+        var reminder = Assert.Single(tasks);
+        Assert.Equal(new TimeOnly(20, 0), reminder.ScheduledTime);
+    }
+
+    [Fact]
+    public async Task MedicationReminder_ConfirmedDoseIsNotRemindedAgain()
+    {
+        await using var db = CreateDbContext();
+        var userId = Guid.NewGuid();
+        var medicationId = Guid.NewGuid();
+        var confirmedAt = new DateTime(2026, 6, 20, 12, 0, 0, DateTimeKind.Utc);
+        db.Medications.Add(new Medication
+        {
+            Id = medicationId,
+            UserId = userId,
+            Name = "测试药物",
+            Frequency = MedicationFrequency.Daily,
+            TimeOfDay = [new TimeOnly(20, 0)],
+            StartDate = new DateOnly(2026, 6, 20),
+            IsActive = true,
+        });
+        db.MedicationLogs.Add(new MedicationLog
+        {
+            Id = Guid.NewGuid(),
+            UserId = userId,
+            MedicationId = medicationId,
+            Status = MedicationLogStatus.Taken,
+            ScheduledTime = new TimeOnly(20, 0),
+            ConfirmedAt = confirmedAt,
+            CreatedAt = confirmedAt,
+        });
+        await db.SaveChangesAsync();
+        var scanner = new MedicationReminderScanner(new EfMedicationRepository(db));
+
+        var tasks = await scanner.ScanAsync(
+            new DateTime(2026, 6, 20, 12, 2, 0, DateTimeKind.Utc),
+            CancellationToken.None);
+
+        Assert.Empty(tasks);
+    }
+
     private static ReportAnalysisTaskRecord NewReportTask(int attempts) => new()
     {
         Id = Guid.NewGuid(),