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

doctor_web/src/pages/reports/ReportDetailPage.tsx

@@ -3,129 +3,252 @@ import { useParams, useNavigate } from 'react-router-dom';
 import { api } from '../../services/api-client';
 import type { Report } from '../../types';
 
+const SEVERITY_OPTIONS = [
+  { value: 'Normal', label: '🟢 正常', desc: '各项指标均在参考范围内' },
+  { value: 'Abnormal', label: '🟡 轻度异常', desc: '存在轻微偏离，无需紧急处理' },
+  { value: 'Severe', label: '🟠 中度异常', desc: '需进一步检查或调整用药' },
+  { value: 'Critical', label: '🔴 重度异常', desc: '需立即干预或就医' },
+];
+
+const RECOMMENDATION_TEMPLATES: Record<string, string[]> = {
+  '用药调整': ['建议继续当前用药方案，无需调整', '建议增加药量至____，两周后复查', '建议减少药量至____，观察不良反应', '建议更换为____，原因：____'],
+  '复查建议': ['建议1个月后复查血常规', '建议3个月后复查心电图', '建议半年后全面复查', '建议进行心脏彩超检查'],
+  '生活方式': ['建议低盐低脂饮食', '建议每日散步30分钟', '建议控制体重，目标____kg', '建议戒烟限酒'],
+  '其他': ['指标正常，继续保持', '建议定期监测血压', '注意休息，避免劳累'],
+};
+
+const SEVERITY_COLORS: Record<string, string> = {
+  Normal: '#20C997', Abnormal: '#F59E0B', Severe: '#EF4444', Critical: '#DC2626',
+};
+
 export default function ReportDetailPage() {
   const { id } = useParams<{ id: string }>();
   const nav = useNavigate();
   const [report, setReport] = useState<Report | null>(null);
-  const [comment, setComment] = useState('');
+  const [severity, setSeverity] = useState('Normal');
+  const [selectedRecommendations, setSelectedRecommendations] = useState<string[]>([]);
+  const [customRecommendation, setCustomRecommendation] = useState('');
+  const [doctorComment, setDoctorComment] = useState('');
   const [submitting, setSubmitting] = useState(false);
   const [success, setSuccess] = useState(false);
 
   useEffect(() => {
-    if (id) api.get<Report>(`/api/doctor/reports/${id}`).then(r => { setReport(r); setComment(r.doctorComment || ''); }).catch(() => {});
+    if (id) api.get<Report>(`/api/doctor/reports/${id}`).then(r => {
+      setReport(r);
+      setDoctorComment(r.doctorComment || '');
+      setSeverity(r.severity || 'Normal');
+    }).catch(() => {});
   }, [id]);
 
+  function toggleRecommendation(item: string) {
+    setSelectedRecommendations(prev =>
+      prev.includes(item) ? prev.filter(i => i !== item) : [...prev, item]
+    );
+  }
+
   async function submitReview() {
     if (!id) return;
     setSubmitting(true);
     try {
-      await api.post(`/api/doctor/reports/${id}/review`, { comment });
+      const recommendation = [
+        ...selectedRecommendations,
+        ...(customRecommendation.trim() ? [customRecommendation.trim()] : []),
+      ].join('\n');
+      await api.post(`/api/doctor/reports/${id}/review`, {
+        severity,
+        comment: doctorComment,
+        recommendation,
+      });
       setSuccess(true);
+      // 刷新报告状态
+      const updated = await api.get<Report>(`/api/doctor/reports/${id}`);
+      setReport(updated);
     } catch { alert('提交失败'); }
     setSubmitting(false);
   }
 
   if (!report) return <div style={{ padding: 40, color: '#9BA0B4' }}>加载中...</div>;
 
-  // 解析 AI 指标
   let indicators: any[] = [];
   try { indicators = JSON.parse(report.aiIndicators || '[]'); } catch {}
 
+  const isReviewed = report.status === 'DoctorReviewed';
+  const sevColor = SEVERITY_COLORS[severity] || '#9BA0B4';
+
   return (
-    <div style={{ padding: 32, maxWidth: 900 }}>
+    <div style={{ padding: 32, maxWidth: 960 }}>
+      {/* 顶栏 */}
       <div style={{ display: 'flex', alignItems: 'center', gap: 12, marginBottom: 24 }}>
-        <button onClick={() => nav(-1)} style={{ color: '#4F6EF7', fontSize: 14, border: 'none', background: 'none', cursor: 'pointer' }}>← 返回</button>
-        <h1 style={{ fontSize: 24, fontWeight: 700 }}>报告详情</h1>
+        <button onClick={() => nav(-1)} style={{ color: '#4F6EF7', fontSize: 14, border: 'none', background: 'none', cursor: 'pointer' }}>← 返回列表</button>
+        <h1 style={{ fontSize: 22, fontWeight: 700, flex: 1 }}>报告审核</h1>
+        <span style={{ padding: '3px 14px', borderRadius: 10, fontSize: 13, fontWeight: 500,
+          background: isReviewed ? '#E6F9F2' : '#FFF8E6',
+          color: isReviewed ? '#20C997' : '#F59E0B' }}>
+          {isReviewed ? '✓ 已审核' : '⏳ 待审核'}
+        </span>
       </div>
 
-      {/* 基本信息 */}
-      <div style={{ background: '#FFF', borderRadius: 16, padding: 24, marginBottom: 20, boxShadow: '0 2px 12px rgba(0,0,0,0.04)' }}>
-        <div style={{ display: 'grid', gridTemplateColumns: '1fr 1fr', gap: '8px 24px', fontSize: 14 }}>
-          <div><span style={{ color: '#9BA0B4' }}>患者：</span>{report.patientName || '-'}</div>
-          <div><span style={{ color: '#9BA0B4' }}>类型：</span>{report.category}</div>
-          <div><span style={{ color: '#9BA0B4' }}>上传时间：</span>{new Date(report.createdAt).toLocaleString('zh-CN')}</div>
-          <div>
-            <span style={{ color: '#9BA0B4' }}>状态：</span>
-            <span style={{ padding: '2px 10px', borderRadius: 10, fontSize: 12, background: report.status === 'PendingDoctor' ? '#FFF8E6' : '#E6F9F2', color: report.status === 'PendingDoctor' ? '#F59E0B' : '#20C997' }}>
-              {report.status === 'PendingDoctor' ? '待审核' : '已审核'}
-            </span>
+      {/* 患者 + 报告信息 */}
+      <div style={{ background: '#FFF', borderRadius: 14, padding: '16px 24px', marginBottom: 20, boxShadow: '0 1px 8px rgba(0,0,0,0.04)', display: 'flex', gap: 32, fontSize: 14 }}>
+        <span>👤 <b>{report.patientName || '-'}</b></span>
+        <span>📋 {report.category}</span>
+        <span>📅 {new Date(report.createdAt).toLocaleDateString('zh-CN')}</span>
+        {report.fileUrl && (
+          <a href={`http://localhost:5000${report.fileUrl}`} target="_blank" rel="noopener noreferrer"
+            style={{ color: '#4F6EF7', marginLeft: 'auto' }}>
+            📎 查看原始报告
+          </a>
+        )}
+      </div>
+
+      <div style={{ display: 'grid', gridTemplateColumns: '1fr 1fr', gap: 20 }}>
+        {/* 左列：AI 预解读 */}
+        <div>
+          <div style={{ background: '#FFF', borderRadius: 14, padding: 24, boxShadow: '0 1px 8px rgba(0,0,0,0.04)' }}>
+            <div style={{ fontSize: 15, fontWeight: 600, marginBottom: 16, display: 'flex', alignItems: 'center', gap: 8 }}>
+              <span>🤖</span> AI 预解读
+              <span style={{ fontSize: 11, color: '#F59E0B', background: '#FFF8E6', padding: '2px 8px', borderRadius: 6, fontWeight: 400 }}>仅供参考</span>
+            </div>
+            {report.aiSummary ? (
+              <div style={{ fontSize: 13, lineHeight: 1.8, color: '#5A6072', marginBottom: 16, padding: '12px 16px', background: '#FAFBFD', borderRadius: 10, whiteSpace: 'pre-wrap' }}>
+                {report.aiSummary}
+              </div>
+            ) : (
+              <div style={{ fontSize: 13, color: '#CCC', marginBottom: 16 }}>AI 分析中，请稍后刷新...</div>
+            )}
+            {indicators.length > 0 && (
+              <table style={{ width: '100%', borderCollapse: 'collapse', fontSize: 12 }}>
+                <thead>
+                  <tr style={{ borderBottom: '2px solid #EDF0F7' }}>
+                    {['指标', '结果', '单位', '参考范围', '状态'].map(h => (
+                      <th key={h} style={{ padding: '6px 8px', textAlign: 'left', color: '#9BA0B4', fontWeight: 500, fontSize: 11 }}>{h}</th>
+                    ))}
+                  </tr>
+                </thead>
+                <tbody>
+                  {indicators.map((ind: any, i: number) => {
+                    const abnormal = ind.status === 'high';
+                    const low = ind.status === 'low';
+                    return (
+                      <tr key={i} style={{ borderBottom: '1px solid #F5F5F5' }}>
+                        <td style={{ padding: '7px 8px', fontSize: 13 }}>{ind.name}</td>
+                        <td style={{ padding: '7px 8px', fontWeight: 600, fontSize: 13, color: abnormal ? '#EF4444' : low ? '#F59E0B' : '#20C997' }}>{ind.value}</td>
+                        <td style={{ padding: '7px 8px', color: '#9BA0B4', fontSize: 12 }}>{ind.unit || '-'}</td>
+                        <td style={{ padding: '7px 8px', color: '#9BA0B4', fontSize: 12 }}>{ind.referenceRange || '-'}</td>
+                        <td style={{ padding: '7px 8px' }}>
+                          <span style={{ padding: '1px 6px', borderRadius: 6, fontSize: 10, fontWeight: 500,
+                            background: abnormal ? '#FEE2E2' : low ? '#FFF8E6' : '#E6F9F2',
+                            color: abnormal ? '#EF4444' : low ? '#F59E0B' : '#20C997' }}>
+                            {abnormal ? '↑高' : low ? '↓低' : '正常'}
+                          </span>
+                        </td>
+                      </tr>
+                    );
+                  })}
+                </tbody>
+              </table>
+            )}
           </div>
         </div>
-        {report.fileUrl && (
-          <div style={{ marginTop: 16 }}>
-            <a href={`http://localhost:5000${report.fileUrl}`} target="_blank" rel="noopener noreferrer"
-              style={{ color: '#4F6EF7', fontSize: 13, textDecoration: 'underline' }}>
-              📎 查看原始文件
-            </a>
-          </div>
-        )}
-      </div>
 
-      {/* AI 预解读 */}
-      <div style={{ background: '#FFF', borderRadius: 16, padding: 24, marginBottom: 20, boxShadow: '0 2px 12px rgba(0,0,0,0.04)' }}>
-        <h2 style={{ fontSize: 16, fontWeight: 600, marginBottom: 16 }}>🤖 AI 预解读</h2>
-        {report.aiSummary && (
-          <div style={{ fontSize: 14, lineHeight: 1.7, color: '#5A6072', marginBottom: 16, padding: '12px 16px', background: '#FAFBFD', borderRadius: 10 }}>
-            {report.aiSummary}
-          </div>
-        )}
-        {indicators.length > 0 && (
-          <table style={{ width: '100%', borderCollapse: 'collapse', fontSize: 13 }}>
-            <thead>
-              <tr style={{ borderBottom: '2px solid #EDF0F7' }}>
-                {['指标', '结果', '单位', '参考范围', '状态'].map(h => (
-                  <th key={h} style={{ padding: '8px 12px', textAlign: 'left', color: '#9BA0B4', fontWeight: 500 }}>{h}</th>
+        {/* 右列：医生审核 */}
+        <div>
+          <div style={{ background: '#FFF', borderRadius: 14, padding: 24, boxShadow: '0 1px 8px rgba(0,0,0,0.04)' }}>
+            <div style={{ fontSize: 15, fontWeight: 600, marginBottom: 20, display: 'flex', alignItems: 'center', gap: 8 }}>
+              <span>👨‍⚕️</span> 医生审核
+            </div>
+            {success && (
+              <div style={{ marginBottom: 16, padding: '10px 16px', background: '#E6F9F2', borderRadius: 10, color: '#20C997', fontWeight: 500, fontSize: 13 }}>
+                ✓ 审核已提交成功
+              </div>
+            )}
+
+            {/* 严重程度 */}
+            <div style={{ marginBottom: 20 }}>
+              <div style={{ fontSize: 13, fontWeight: 500, color: '#5A6072', marginBottom: 8 }}>严重程度评估</div>
+              <div style={{ display: 'grid', gridTemplateColumns: '1fr 1fr', gap: 6 }}>
+                {SEVERITY_OPTIONS.map(opt => (
+                  <button key={opt.value} onClick={() => setSeverity(opt.value)} disabled={isReviewed}
+                    style={{
+                      padding: '10px 12px', borderRadius: 8, border: severity === opt.value ? `2px solid ${sevColor}` : '2px solid #EDF0F7',
+                      background: severity === opt.value ? `${sevColor}10` : '#FFF',
+                      textAlign: 'left', cursor: isReviewed ? 'default' : 'pointer', opacity: isReviewed ? 0.7 : 1,
+                    }}>
+                    <div style={{ fontSize: 13, fontWeight: 600 }}>{opt.label}</div>
+                    <div style={{ fontSize: 10, color: '#9BA0B4', marginTop: 2 }}>{opt.desc}</div>
+                  </button>
                 ))}
-              </tr>
-            </thead>
-            <tbody>
-              {indicators.map((ind: any, i: number) => {
-                const abnormal = ind.status === 'high' || ind.status === 'abnormal';
-                const low = ind.status === 'low';
-                return (
-                  <tr key={i} style={{ borderBottom: '1px solid #F2F3F7' }}>
-                    <td style={{ padding: '8px 12px' }}>{ind.name}</td>
-                    <td style={{ padding: '8px 12px', fontWeight: 500, color: abnormal ? '#EF4444' : low ? '#F59E0B' : '#20C997' }}>{ind.value}</td>
-                    <td style={{ padding: '8px 12px', color: '#5A6072' }}>{ind.unit || '-'}</td>
-                    <td style={{ padding: '8px 12px', color: '#5A6072' }}>{ind.range || '-'}</td>
-                    <td style={{ padding: '8px 12px' }}>
-                      <span style={{ padding: '2px 8px', borderRadius: 8, fontSize: 11, background: abnormal ? '#FEE2E2' : low ? '#FFF8E6' : '#E6F9F2', color: abnormal ? '#EF4444' : low ? '#F59E0B' : '#20C997' }}>
-                        {abnormal ? '偏高' : low ? '偏低' : '正常'}
-                      </span>
-                    </td>
-                  </tr>
-                );
-              })}
-            </tbody>
-          </table>
-        )}
-      </div>
+              </div>
+            </div>
 
-      {/* 医生审核 */}
-      <div style={{ background: '#FFF', borderRadius: 16, padding: 24, boxShadow: '0 2px 12px rgba(0,0,0,0.04)' }}>
-        <h2 style={{ fontSize: 16, fontWeight: 600, marginBottom: 16 }}>👨‍⚕️ 医生审核意见</h2>
-        {success && (
-          <div style={{ marginBottom: 16, padding: '12px 18px', background: '#E6F9F2', borderRadius: 10, color: '#20C997', fontWeight: 500, fontSize: 14 }}>
-            ✓ 审核已提交
+            {/* 快速建议模板 */}
+            <div style={{ marginBottom: 20 }}>
+              <div style={{ fontSize: 13, fontWeight: 500, color: '#5A6072', marginBottom: 8 }}>建议模板（可多选）</div>
+              {Object.entries(RECOMMENDATION_TEMPLATES).map(([category, items]) => (
+                <div key={category} style={{ marginBottom: 10 }}>
+                  <div style={{ fontSize: 11, color: '#9BA0B4', marginBottom: 4, fontWeight: 500 }}>{category}</div>
+                  <div style={{ display: 'flex', flexWrap: 'wrap', gap: 4 }}>
+                    {items.map(item => {
+                      const selected = selectedRecommendations.includes(item);
+                      return (
+                        <button key={item} onClick={() => !isReviewed && toggleRecommendation(item)} disabled={isReviewed}
+                          style={{
+                            padding: '4px 10px', borderRadius: 6, border: selected ? '1px solid #4F6EF7' : '1px solid #E1E5ED',
+                            background: selected ? '#EDF2FF' : '#FFF', color: selected ? '#4F6EF7' : '#5A6072',
+                            fontSize: 12, cursor: isReviewed ? 'default' : 'pointer',
+                          }}>
+                          {item.length > 20 ? item.slice(0, 20) + '...' : item}
+                        </button>
+                      );
+                    })}
+                  </div>
+                </div>
+              ))}
+            </div>
+
+            {/* 自定义建议 */}
+            <div style={{ marginBottom: 20 }}>
+              <div style={{ fontSize: 13, fontWeight: 500, color: '#5A6072', marginBottom: 6 }}>补充建议</div>
+              <textarea value={customRecommendation} onChange={e => setCustomRecommendation(e.target.value)} disabled={isReviewed}
+                placeholder="输入其他建议..."
+                rows={2}
+                style={{ width: '100%', padding: 10, border: '1px solid #E1E5ED', borderRadius: 8, fontSize: 13, outline: 'none', resize: 'vertical' }} />
+            </div>
+
+            {/* 医生评语 */}
+            <div style={{ marginBottom: 20 }}>
+              <div style={{ fontSize: 13, fontWeight: 500, color: '#5A6072', marginBottom: 6 }}>综合评语</div>
+              <textarea value={doctorComment} onChange={e => setDoctorComment(e.target.value)} disabled={isReviewed}
+                placeholder="输入对患者的综合评语..."
+                rows={3}
+                style={{ width: '100%', padding: 10, border: '1px solid #E1E5ED', borderRadius: 8, fontSize: 13, outline: 'none', resize: 'vertical' }} />
+            </div>
+
+            {/* 提交按钮 */}
+            {!isReviewed && (
+              <button onClick={submitReview} disabled={submitting}
+                style={{
+                  width: '100%', padding: '12px 0', borderRadius: 10, border: 'none', fontSize: 15, fontWeight: 600,
+                  background: submitting ? '#E1E5ED' : 'linear-gradient(135deg, #4F6EF7, #6C8AFF)',
+                  color: submitting ? '#9BA0B4' : '#FFF', cursor: submitting ? 'default' : 'pointer',
+                }}>
+                {submitting ? '提交中...' : '✓ 提交审核意见'}
+              </button>
+            )}
+
+            {/* 已审核时展示历史记录 */}
+            {isReviewed && (
+              <div style={{ marginTop: 12, padding: '12px 16px', background: '#FAFBFD', borderRadius: 10, fontSize: 13 }}>
+                <div style={{ color: '#9BA0B4', marginBottom: 6 }}>审核记录</div>
+                {report.severity && <div>📊 严重程度：{SEVERITY_OPTIONS.find(o => o.value === report.severity)?.label || report.severity}</div>}
+                {report.doctorComment && <div style={{ marginTop: 6 }}>💬 {report.doctorComment}</div>}
+                {report.doctorRecommendation && <div style={{ marginTop: 4, whiteSpace: 'pre-wrap' }}>📝 {report.doctorRecommendation}</div>}
+                <div style={{ color: '#9BA0B4', marginTop: 4, fontSize: 11 }}>
+                  {report.doctorName} · {report.reviewedAt ? new Date(report.reviewedAt).toLocaleString('zh-CN') : ''}
+                </div>
+              </div>
+            )}
           </div>
-        )}
-        <textarea
-          value={comment}
-          onChange={e => setComment(e.target.value)}
-          placeholder="请输入您的专业解读意见..."
-          rows={5}
-          style={{ width: '100%', padding: 14, border: '1px solid #E1E5ED', borderRadius: 12, fontSize: 14, outline: 'none', resize: 'vertical' }}
-        />
-        <div style={{ marginTop: 16, display: 'flex', justifyContent: 'flex-end' }}>
-          <button onClick={submitReview} disabled={submitting || !comment.trim()}
-            style={{
-              padding: '12px 32px',
-              background: submitting || !comment.trim() ? '#E1E5ED' : 'linear-gradient(135deg, #4F6EF7, #6C8AFF)',
-              color: submitting || !comment.trim() ? '#9BA0B4' : '#FFF',
-              border: 'none', borderRadius: 12, fontSize: 15, fontWeight: 600,
-            }}>
-            {submitting ? '提交中...' : '提交审核意见'}
-          </button>
         </div>
       </div>
     </div>

doctor_web/src/types/index.ts

@@ -103,9 +103,11 @@ export interface Report {
   fileType: string;
   category: string;
   status: string;
+  severity: string | null;
   aiSummary: string | null;
   aiIndicators: string | null;
   doctorComment: string | null;
+  doctorRecommendation: string | null;
   doctorName: string | null;
   reviewedAt: string | null;
   createdAt: string;