7a93237069
- 后端: 新增 AttachmentContextBuilder 解析图片/PDF 摘要并拼入 LLM 上下文; ai_chat_endpoints 扩展附件接口; 新增 ReportAnalysisService - 前端: 新增历史会话页与 conversation_history_provider; chat 链路支持附件展示与回放 - UI: 重构 medication_checkin / notification_center / profile / health_drawer 等多页面 - 配置: api_client baseUrl 适配当前 WiFi IP
259 lines
11 KiB
C#
259 lines
11 KiB
C#
using Health.Application.Reports;
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using Health.Application.Notifications;
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using Health.Infrastructure.AI;
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using Microsoft.Extensions.Logging;
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using UglyToad.PdfPig;
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namespace Health.Infrastructure.Reports;
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public sealed class ReportAnalysisService(
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IReportRepository reports,
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VisionClient vision,
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DeepSeekClient llm,
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IUserNotificationProducer notifications,
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ILogger<ReportAnalysisService> logger) : IReportAnalysisService
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{
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private readonly IReportRepository _reports = reports;
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private readonly VisionClient _vision = vision;
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private readonly DeepSeekClient _llm = llm;
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private readonly IUserNotificationProducer _notifications = notifications;
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private readonly ILogger<ReportAnalysisService> _logger = logger;
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private const int MaxPdfChars = 8000;
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public async Task AnalyzeAsync(ReportAnalysisJob job, CancellationToken ct)
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{
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var report = await _reports.GetByIdAsync(job.ReportId, ct);
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if (report == null) return;
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try
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{
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var vlmJson = await ExtractIndicatorsAsync(job.FilePath, ct);
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var isReport = vlmJson.TryGetProperty("isReport", out var ir) && ir.GetBoolean();
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var reason = vlmJson.TryGetProperty("reason", out var rsn) ? rsn.GetString() : null;
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if (!isReport)
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{
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report.AiSummary = $"AI 暂时无法完成解读：{reason ?? "这可能不是一份医学报告"}。请重新上传清晰的报告图片。";
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report.AiIndicators = "[]";
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report.Status = ReportStatus.AnalysisFailed;
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await _reports.SaveChangesAsync(ct);
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await NotifyAsync(report, job.TaskId, false, ct);
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return;
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}
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var reportType = vlmJson.TryGetProperty("reportType", out var rt) ? rt.GetString() ?? "Other" : "Other";
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var indicatorsJson = vlmJson.TryGetProperty("indicators", out var inds) ? inds.GetRawText() : "[]";
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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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report.AiSummary = await GenerateSummaryAsync(indicatorsJson, ct);
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report.Status = ReportStatus.PendingDoctor;
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await _reports.SaveChangesAsync(ct);
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await NotifyAsync(report, job.TaskId, true, ct);
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_logger.LogInformation("报告 AI 分析完成: {ReportId}", job.ReportId);
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}
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catch (OperationCanceledException) when (ct.IsCancellationRequested)
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{
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// 进程停机导致的取消：不算失败，不消耗重试，交还给恢复机制
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throw;
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}
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catch (Exception ex)
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{
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_logger.LogError(ex, "报告 AI 分析失败: {ReportId}", job.ReportId);
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report.Status = ReportStatus.AnalysisFailed;
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report.AiSummary = "AI 暂时无法完成解读，可能是图片不清晰或服务暂时不可用。请稍后重试，或重新上传更清晰的报告图片。";
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report.AiIndicators = "[]";
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await _reports.SaveChangesAsync(ct);
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// 重新抛出，使 Worker 进入 RetryAsync（指数退避重试，超限后任务置 Failed）；
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// 若为可恢复的瞬时故障，重试成功会把状态改回 PendingDoctor。
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throw;
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}
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}
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private async Task<JsonElement> ExtractIndicatorsAsync(string filePath, CancellationToken ct)
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{
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if (Path.GetExtension(filePath).Equals(".pdf", StringComparison.OrdinalIgnoreCase))
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return await ExtractIndicatorsFromPdfAsync(filePath, ct);
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var imageUrl = await GetLocalImageUrl(filePath, ct);
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if (imageUrl == null)
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throw new InvalidOperationException("报告图片文件不存在或无法读取");
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var prompt = """
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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 response = await _vision.VisionAsync(
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prompt,
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[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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ct: ct);
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var content = response.Choices?.FirstOrDefault()?.Message?.Content ?? "";
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// 不记录 VLM 返回正文：可能包含检验指标等敏感医疗信息，生产日志只记录长度
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_logger.LogInformation("报告 VLM 返回长度: {Length}", content.Length);
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var json = TryParseJson(content);
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return json ?? throw new InvalidOperationException("报告识别结果格式异常");
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}
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private async Task<JsonElement> ExtractIndicatorsFromPdfAsync(string filePath, CancellationToken ct)
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{
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var text = ExtractPdfText(filePath);
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if (string.IsNullOrWhiteSpace(text))
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{
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return JsonDocument.Parse("""
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{"isReport": false, "reason": "这份 PDF 可能是扫描件或图片版，当前无法直接提取文字。请上传清晰图片，或后续启用 PDF 页转图片后再用 VLM 识别。"}
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""").RootElement;
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}
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var prompt = $$"""
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你是一名医学检验报告分析专家。下面是用户上传 PDF 中提取出的文字。
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PDF 文本：
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{{text}}
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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，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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- 只提取报告里真实出现的指标
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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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- 不确定的参考范围不要编造，可留空
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""";
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var messages = new List<ChatMessage>
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{
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new() { Role = "system", Content = "你是医学报告结构化抽取助手，只输出严格 JSON。" },
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new() { Role = "user", Content = prompt }
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};
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var response = await _llm.ChatAsync(messages, maxTokens: 1800, temperature: 0.1f, ct: ct);
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var content = response.Choices?.FirstOrDefault()?.Message?.Content ?? "";
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var json = TryParseJson(content);
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return json ?? throw new InvalidOperationException("PDF 报告解析结果格式异常");
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}
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private static string ExtractPdfText(string filePath)
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{
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using var pdf = PdfDocument.Open(filePath);
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var sb = new System.Text.StringBuilder();
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foreach (var page in pdf.GetPages())
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{
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sb.AppendLine(page.Text);
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if (sb.Length > MaxPdfChars) break;
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}
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var text = sb.ToString().Trim();
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return text.Length > MaxPdfChars ? text[..MaxPdfChars] : text;
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}
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private async Task<string> GenerateSummaryAsync(string indicatorsJson, CancellationToken ct)
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{
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var prompt = $"""
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你是患者端医学报告预解读助手。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：{indicatorsJson}
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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，但不要给出确定诊断
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4. 给出生活方式和复查/就医沟通建议，不要给出处方、停药、换药或调药建议
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5. 如指标明显异常或存在急症风险，优先建议及时就医
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6. 末尾提醒"以上为AI预解读，不能替代医生诊断和治疗建议"
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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 messages = new List<ChatMessage>
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{
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new() { Role = "system", Content = "你是患者端医学报告预解读助手，不替代医生诊断、处方或治疗决策。" },
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new() { Role = "user", Content = prompt }
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};
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var response = await _llm.ChatAsync(messages, maxTokens: 800, temperature: 0.3f, ct: ct);
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var summary = response.Choices?.FirstOrDefault()?.Message?.Content?.Trim() ?? "";
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return !string.IsNullOrWhiteSpace(summary)
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? summary
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: throw new InvalidOperationException("AI 未返回有效解读内容");
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}
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private static async Task<string?> GetLocalImageUrl(string filePath, CancellationToken ct)
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{
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if (!File.Exists(filePath)) return null;
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var bytes = await File.ReadAllBytesAsync(filePath, ct);
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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
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{
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"png" => "image/png",
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"jpg" or "jpeg" => "image/jpeg",
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"webp" => "image/webp",
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_ => "image/png"
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};
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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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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 (JsonException) { return null; }
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}
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private Task NotifyAsync(Report report, Guid sourceId, bool succeeded, CancellationToken ct) =>
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_notifications.EnqueueAsync(
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report.UserId,
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sourceId,
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new NotificationMessage(
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succeeded ? "ReportAnalysisCompleted" : "ReportAnalysisFailed",
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succeeded ? "报告分析完成" : "报告分析未完成",
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succeeded ? "您的报告已完成 AI 预解读，点击查看分析结果。" : "这份报告暂时无法完成分析，您可以进入报告页面重新尝试。",
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succeeded ? "success" : "warning",
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"report",
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report.Id.ToString()),
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ct);
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}
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