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

health_app/lib/services/in_app_notification_service.dart

@@ -5,12 +5,22 @@ class InAppNotification {
   final String type;
   final String title;
   final String message;
+  final String severity;
+  final String? actionType;
+  final String? actionTargetId;
+  final bool isRead;
+  final DateTime createdAt;
 
   const InAppNotification({
     required this.id,
     required this.type,
     required this.title,
     required this.message,
+    required this.severity,
+    this.actionType,
+    this.actionTargetId,
+    required this.isRead,
+    required this.createdAt,
   });
 
   factory InAppNotification.fromJson(Map<String, dynamic> json) =>
@@ -19,7 +29,36 @@ class InAppNotification {
         type: json['type']?.toString() ?? '',
         title: json['title']?.toString() ?? '健康提醒',
         message: json['message']?.toString() ?? '',
+        severity: json['severity']?.toString() ?? 'info',
+        actionType: json['actionType']?.toString(),
+        actionTargetId: json['actionTargetId']?.toString(),
+        isRead: json['isRead'] == true,
+        createdAt:
+            DateTime.tryParse(json['createdAt']?.toString() ?? '') ??
+            DateTime.now(),
       );
+
+  InAppNotification copyWith({bool? isRead}) => InAppNotification(
+    id: id,
+    type: type,
+    title: title,
+    message: message,
+    severity: severity,
+    actionType: actionType,
+    actionTargetId: actionTargetId,
+    isRead: isRead ?? this.isRead,
+    createdAt: createdAt,
+  );
+}
+
+class InAppNotificationHistory {
+  final int unreadCount;
+  final List<InAppNotification> items;
+
+  const InAppNotificationHistory({
+    required this.unreadCount,
+    required this.items,
+  });
 }
 
 class InAppNotificationService {
@@ -32,7 +71,9 @@ class InAppNotificationService {
     final items = response.data['data'] as List? ?? const [];
     return items
         .whereType<Map>()
-        .map((item) => InAppNotification.fromJson(Map<String, dynamic>.from(item)))
+        .map(
+          (item) => InAppNotification.fromJson(Map<String, dynamic>.from(item)),
+        )
         .where((item) => item.id.isNotEmpty)
         .toList();
   }
@@ -40,4 +81,29 @@ class InAppNotificationService {
   Future<void> acknowledge(String id) async {
     await _api.post('/api/notifications/$id/acknowledge');
   }
+
+  Future<void> markAllRead() async {
+    await _api.post('/api/notifications/read-all');
+  }
+
+  Future<InAppNotificationHistory> getHistory() async {
+    final response = await _api.get('/api/notifications');
+    final data = response.data['data'] as Map? ?? const {};
+    final rawItems = data['items'] as List? ?? const [];
+    return InAppNotificationHistory(
+      unreadCount: data['unreadCount'] as int? ?? 0,
+      items: rawItems
+          .whereType<Map>()
+          .map(
+            (item) =>
+                InAppNotification.fromJson(Map<String, dynamic>.from(item)),
+          )
+          .where((item) => item.id.isNotEmpty)
+          .toList(),
+    );
+  }
+
+  Future<void> delete(String id) async {
+    await _api.delete('/api/notifications/$id');
+  }
 }