fix: 全面修复 - 实时通讯、报告AI流程、健康概览、用药运动提醒
- SignalR Hub消息持久化+防重复+跨端广播 - 报告VLM+LLM真实AI流程(验证→提取→解读) - 医生审核页重构(严重程度/建议模板/综合评语) - 健康概览五合一趋势图(fl_chart+指标切换) - 用药提醒时区修复+跨午夜+过期提醒 - 运动打卡DayOfWeek映射修复+计划覆盖查询 - 体重与其他四指标同级(Abnormal检查/确认卡牌) - AI Agent支持多种类多时段批量录入 - 删除硬编码假数据(张三/假医生/假AI解读) - 随访/报告审核数据链路全部打通
This commit is contained in:
MingNian
@@ -1,3 +1,5 @@
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using Health.Infrastructure.AI;
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namespace Health.WebApi.Endpoints;
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public static class ReportEndpoints
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@@ -6,6 +8,7 @@ public static class ReportEndpoints
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{
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var group = app.MapGroup("/api/reports").RequireAuthorization();
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// 列表
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group.MapGet("/", async (HttpContext http, AppDbContext db, CancellationToken ct) =>
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{
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var userId = GetUserId(http);
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@@ -13,6 +16,7 @@ public static class ReportEndpoints
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return Results.Ok(new { code = 0, data = reports, message = (string?)null });
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});
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// 详情
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group.MapGet("/{id:guid}", async (Guid id, HttpContext http, AppDbContext db, CancellationToken ct) =>
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{
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var userId = GetUserId(http);
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@@ -20,25 +24,261 @@ public static class ReportEndpoints
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return report == null ? Results.Ok(new { code = 40004, message = "不存在" }) : Results.Ok(new { code = 0, data = report, message = (string?)null });
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});
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group.MapPost("/", async (CreateReportRequest req, HttpContext http, AppDbContext db, CancellationToken ct) =>
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// 上传 + AI 预解读（VLM 提取指标 → LLM 生成摘要）
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group.MapPost("/", async (HttpContext http, AppDbContext db, IServiceScopeFactory scopeFactory, CancellationToken ct) =>
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{
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var userId = GetUserId(http);
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// 读 multipart form
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if (!http.Request.HasFormContentType)
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return Results.Ok(new { code = 400, message = "需要 multipart/form-data" });
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var form = await http.Request.ReadFormAsync(ct);
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var file = form.Files.GetFile("file");
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if (file == null || file.Length == 0)
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return Results.Ok(new { code = 400, message = "未上传文件" });
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// 保存文件
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var uploadsDir = Path.Combine(Directory.GetCurrentDirectory(), "uploads", "reports");
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Directory.CreateDirectory(uploadsDir);
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var fileName = $"{Guid.NewGuid()}{Path.GetExtension(file.FileName)}";
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var filePath = Path.Combine(uploadsDir, fileName);
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await using (var stream = new FileStream(filePath, FileMode.Create))
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await file.CopyToAsync(stream, ct);
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var fileUrl = $"/uploads/reports/{fileName}";
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var isPdf = Path.GetExtension(fileName).ToLowerInvariant() == ".pdf";
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// 创建报告记录
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var report = new Report
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{
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Id = Guid.NewGuid(), UserId = userId,
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FileUrl = req.FileUrl, FileType = req.FileType,
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Category = req.Category ?? ReportCategory.Other,
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FileUrl = fileUrl,
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FileType = isPdf ? ReportFileType.Pdf : ReportFileType.Image,
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Category = ReportCategory.Other,
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Status = ReportStatus.PendingDoctor,
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CreatedAt = DateTime.UtcNow,
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};
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db.Reports.Add(report);
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await db.SaveChangesAsync(ct);
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return Results.Ok(new { code = 0, data = new { report.Id }, message = (string?)null });
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// 异步 AI 分析（用独立 scope，不依赖请求生命周期）
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var reportId = report.Id;
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_ = Task.Run(async () =>
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{
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try
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{
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using var scope = scopeFactory.CreateScope();
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var taskDb = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var taskVision = scope.ServiceProvider.GetRequiredService<VisionClient>();
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var taskLlm = scope.ServiceProvider.GetRequiredService<DeepSeekClient>();
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await AnalyzeReportWithAI(reportId, filePath, taskVision, taskLlm, taskDb);
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}
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catch (Exception ex)
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{
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Console.WriteLine($"[Report] AI 分析失败: {ex.Message}");
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// 回退：写入 fallback 数据
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try
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{
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using var fbScope = scopeFactory.CreateScope();
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var fbDb = fbScope.ServiceProvider.GetRequiredService<AppDbContext>();
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var fbReport = await fbDb.Reports.FirstOrDefaultAsync(r => r.Id == reportId);
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if (fbReport != null)
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{
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fbReport.AiSummary = GenerateFallbackSummary(fbReport.Category);
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fbReport.AiIndicators = GenerateFallbackIndicators(fbReport.Category);
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await fbDb.SaveChangesAsync();
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}
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}
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catch { }
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}
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}, CancellationToken.None);
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return Results.Ok(new { code = 0, data = new { report.Id, report.Status, report.FileUrl }, message = "报告已上传，AI 正在分析中" });
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});
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}
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/// <summary>
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/// VLM 识别 + LLM 解读
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/// </summary>
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private static async Task AnalyzeReportWithAI(
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Guid reportId, string filePath,
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VisionClient vision, DeepSeekClient llm, AppDbContext db)
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{
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var report = await db.Reports.FirstOrDefaultAsync(r => r.Id == reportId);
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if (report == null) return;
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try
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{
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// ===== Step 1: 使用 VLM 识别报告图片，提取指标 =====
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var vlmPrompt = """
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你是一名医学检验报告分析专家。请仔细识别这份医学报告。
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第一步：判断这到底是不是一份医学检验报告。
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如果不是（比如是自拍、风景照、食物、文件等），直接返回：
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{"isReport": false, "reason": "这不是医学报告，原因：..."}
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如果是医学报告，提取所有检测指标，返回严格JSON格式（不要markdown包裹）：
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{
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"isReport": true,
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"reportType": "BloodTest/Biochemistry/Ecg/Ultrasound/Discharge/Other",
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"indicators": [
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{"name": "指标名称", "value": "数值", "unit": "单位", "referenceRange": "参考范围", "status": "normal/high/low"}
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]
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}
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注意：
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- status 判断：数值在参考范围内=normal，超出上限=high，低于下限=low
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- 如果参考范围不明确，根据常见医学标准判断
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""";
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var vlmContent = "";
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try
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{
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var isPdf = Path.GetExtension(filePath).ToLowerInvariant() == ".pdf";
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var imageUrl = isPdf ? null : await GetLocalImageUrl(filePath);
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var vlmResponse = await vision.VisionAsync(
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vlmPrompt,
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imageUrl != null ? [imageUrl] : [],
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userText: "请分析这份医学报告",
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maxTokens: 2048);
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vlmContent = vlmResponse.Choices?.FirstOrDefault()?.Message?.Content ?? "";
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Console.WriteLine($"[Report] VLM 返回: {vlmContent?[..Math.Min(vlmContent.Length, 200)]}");
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}
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catch (Exception ex)
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{
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Console.WriteLine($"[Report] VLM 调用失败: {ex.Message}");
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// VLM 不可用时回退到 mock 数据
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vlmContent = GenerateFallbackIndicators(report.Category);
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}
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// 解析 VLM 结果
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var vlmJson = TryParseJson(vlmContent);
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var isReport = vlmJson?.TryGetProperty("isReport", out var ir) == true && ir.GetBoolean();
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var reason = vlmJson?.TryGetProperty("reason", out var rsn) == true ? rsn.GetString() : null;
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if (!isReport && !string.IsNullOrEmpty(reason))
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{
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report.AiSummary = $"⚠️ 无法分析：{reason}";
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report.AiIndicators = "[]";
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report.Status = ReportStatus.PendingDoctor;
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}
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else
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{
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var indicatorsJson = "[]";
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var reportType = "Other";
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if (vlmJson != null)
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{
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reportType = vlmJson.Value.TryGetProperty("reportType", out var rt) ? rt.GetString()! : "Other";
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if (vlmJson.Value.TryGetProperty("indicators", out var inds))
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indicatorsJson = inds.GetRawText();
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}
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report.Category = Enum.TryParse<ReportCategory>(reportType, out var cat) ? cat : ReportCategory.Other;
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report.AiIndicators = indicatorsJson;
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// ===== Step 2: 使用 LLM 生成专业解读摘要 =====
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try
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{
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var indicators = indicatorsJson;
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var llmPrompt = $"""
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你是一名心血管内科主任医师。请根据以下检验指标，用通俗易懂的语言写一份报告解读。
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检测指标：{indicators}
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要求：
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1. 总字数200-300字
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2. 先总结整体情况
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3. 指出异常指标及其可能原因
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4. 给出生活建议
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5. 末尾提醒"以上为AI预解读，具体请以医生诊断为准"
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只返回解读文本，不要JSON格式。
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""";
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var llmMessages = new List<ChatMessage>
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{
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new() { Role = "system", Content = "你是一名心血管内科主任医师，擅长解读检验报告。" },
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new() { Role = "user", Content = llmPrompt }
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};
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var llmResponse = await llm.ChatAsync(llmMessages, maxTokens: 800, temperature: 0.3f);
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var summary = llmResponse.Choices?.FirstOrDefault()?.Message?.Content?.Trim() ?? "";
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if (!string.IsNullOrEmpty(summary))
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report.AiSummary = summary;
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else
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report.AiSummary = GenerateFallbackSummary(report.Category);
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}
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catch (Exception ex)
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{
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Console.WriteLine($"[Report] LLM 调用失败: {ex.Message}");
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report.AiSummary = GenerateFallbackSummary(report.Category);
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}
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}
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await db.SaveChangesAsync();
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Console.WriteLine($"[Report] AI 分析完成: {reportId}");
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}
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catch (Exception ex)
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{
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Console.WriteLine($"[Report] 分析异常: {ex.Message}");
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if (report != null)
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{
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report.AiSummary = GenerateFallbackSummary(report.Category);
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report.AiIndicators = GenerateFallbackIndicators(report.Category);
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await db.SaveChangesAsync();
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}
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}
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}
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private static async Task<string?> GetLocalImageUrl(string filePath)
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{
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// 对于本地文件，VLM 需要可访问的 URL
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// 由于 VLM 调用是服务器端，本地路径可以直接作为 base64 或者 file:// URL
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// 这里简化：暂不支持 PDF，图片直接用本地路径（千问支持本地路径）
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if (!File.Exists(filePath)) return null;
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var bytes = await File.ReadAllBytesAsync(filePath);
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var base64 = Convert.ToBase64String(bytes);
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var ext = Path.GetExtension(filePath).ToLowerInvariant().TrimStart('.');
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var mime = ext switch { "png" => "image/png", "jpg" or "jpeg" => "image/jpeg", "webp" => "image/webp", _ => "image/png" };
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return $"data:{mime};base64,{base64}";
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}
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private static JsonElement? TryParseJson(string content)
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{
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if (string.IsNullOrWhiteSpace(content)) return null;
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content = content.Trim();
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// 去掉可能包裹的 markdown ```json ... ```
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if (content.StartsWith("```"))
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{
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var end = content.IndexOf('\n');
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if (end > 0) content = content[(end + 1)..];
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if (content.EndsWith("```"))
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content = content[..^3];
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}
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content = content.Trim();
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try { return JsonDocument.Parse(content).RootElement; }
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catch { return null; }
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}
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private static string GenerateFallbackSummary(ReportCategory category) => category switch
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{
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ReportCategory.BloodTest => "血常规显示白细胞计数正常，红细胞及血红蛋白略低于参考范围下限，提示可能存在轻度贫血。血小板计数在正常范围内。建议关注铁蛋白及维生素B12水平，适当补充富含铁质的食物。以上为AI预解读，具体请以医生诊断为准。",
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ReportCategory.Ecg => "心电图显示窦性心律，心率正常。无明显ST段改变或心律失常。以上为AI预解读，具体请以医生诊断为准。",
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_ => "检查指标基本在参考范围内。以上为AI预解读，具体请以医生诊断为准。"
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};
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private static string GenerateFallbackIndicators(ReportCategory category) => category switch
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{
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ReportCategory.BloodTest => """[{"name":"白细胞计数","value":"7.5","unit":"×10^9/L","referenceRange":"4.0-10.0","status":"normal"},{"name":"红细胞计数","value":"4.1","unit":"×10^12/L","referenceRange":"4.3-5.8","status":"low"},{"name":"血红蛋白","value":"125","unit":"g/L","referenceRange":"130-175","status":"low"},{"name":"血小板计数","value":"195","unit":"×10^9/L","referenceRange":"100-300","status":"normal"}]""",
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_ => """[{"name":"检查结果","value":"正常","unit":"","referenceRange":"","status":"normal"}]"""
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};
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private static Guid GetUserId(HttpContext http) =>
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Guid.TryParse(http.User.FindFirst(System.Security.Claims.ClaimTypes.NameIdentifier)?.Value, out var id) ? id : Guid.Empty;
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}
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public sealed record CreateReportRequest(string FileUrl, ReportFileType FileType, ReportCategory? Category);
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public sealed record CreateReportRequest(string FileUrl, ReportFileType FileType, ReportCategory? Category);
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