更新

server/app/adminapi/controller/tcm/DiagnosisController.php

@@ -17,8 +17,10 @@ namespace app\adminapi\controller\tcm;
 use app\adminapi\controller\BaseAdminController;
 use app\adminapi\lists\tcm\DiagnosisLists;
 use app\adminapi\logic\order\OrderActionLogLogic;
-use app\adminapi\logic\tcm\DiagnosisLogic;
-use app\adminapi\logic\tcm\TrackingNoteLogic;
+use app\adminapi\logic\tcm\DiagnosisAiLogic;
+use app\adminapi\logic\tcm\DiagnosisLogic;
+use app\adminapi\logic\tcm\PatientAiReportLogic;
+use app\adminapi\logic\tcm\TrackingNoteLogic;
 use app\adminapi\validate\tcm\DiagnosisValidate;
 use app\common\model\Order;
 use app\common\model\WechatChatRecord;
@@ -222,7 +224,7 @@ class DiagnosisController extends BaseAdminController
 
         return $this->data(DiagnosisLogic::guahaoLogList((int) $params['id']));
     }
-    
+
     /**
      * @notes 诊单详情（患者端）
      * @return \think\response\Json
@@ -230,22 +232,22 @@ class DiagnosisController extends BaseAdminController
     public function diagnosisDetail()
     {
         $params = $this->request->get();
-        
+
         if (empty($params['id'])) {
             return $this->fail('诊单ID不能为空');
         }
-        
+
         if (empty($params['user_id'])) {
             return $this->fail('用户ID不能为空');
         }
-        
+
         $result = DiagnosisLogic::diagnosisDetail($params);
         if ($result) {
             return $this->data($result);
         }
         return $this->fail(DiagnosisLogic::getError());
     }
-    
+
     /**
      * @notes 检查手机号是否重复
      * @return \think\response\Json
@@ -256,7 +258,7 @@ class DiagnosisController extends BaseAdminController
         $result = DiagnosisLogic::checkPhone($params);
         return $this->data($result);
     }
-    
+
     /**
      * @notes 检查身份证号是否重复
      * @return \think\response\Json
@@ -281,7 +283,7 @@ class DiagnosisController extends BaseAdminController
         }
         return $this->fail(DiagnosisLogic::getError());
     }
-    
+
     /**
      * @notes 指派医助
      * @return \think\response\Json
@@ -289,12 +291,12 @@ class DiagnosisController extends BaseAdminController
     public function assign()
     {
         $params = $this->request->post();
-        
+
         // 验证参数
         if (empty($params['id'])) {
             return $this->fail('诊单ID不能为空');
         }
-        
+
         if (!array_key_exists('assistant_id', $params)) {
             return $this->fail('请选择医助或取消指派');
         }
@@ -327,25 +329,25 @@ class DiagnosisController extends BaseAdminController
     public function getCallSignature()
     {
         $params = $this->request->post();
-        
+
         if (empty($params['diagnosis_id'])) {
             return $this->fail('诊单ID不能为空');
         }
-        
+
         if (empty($params['patient_id'])) {
             return $this->fail('患者ID不能为空');
         }
-        
+
         // 传递当前管理员ID
         $params['admin_id'] = $this->adminId;
-        
+
         $result = DiagnosisLogic::getCallSignature($params);
         if ($result) {
             return $this->data($result);
         }
         return $this->fail(DiagnosisLogic::getError());
     }
-    
+
     /**
      * @notes 发起通话
      * @return \think\response\Json
@@ -353,57 +355,57 @@ class DiagnosisController extends BaseAdminController
     public function startCall()
     {
         $params = $this->request->post();
-        
+
         if (empty($params['diagnosis_id'])) {
             return $this->fail('诊单ID不能为空');
         }
-        
+
         // 传递当前管理员ID
         $params['admin_id'] = $this->adminId;
-        
-        $result = DiagnosisLogic::startCall($params, $this->adminInfo);
-        if ($result !== false) {
-            return $this->data($result);
-        }
-        return $this->fail(DiagnosisLogic::getError());
-    }
-
-    /** @notes 为当前医生的指定通话记录启动实时录音转写 */
-    public function startCallTranscription()
-    {
-        $params = $this->request->post();
-        $params['admin_id'] = (int)$this->adminId;
-        $result = DiagnosisLogic::startCallTranscription($params);
-        if ($result === false) {
-            return $this->fail(DiagnosisLogic::getError());
-        }
-        return $this->data($result);
-    }
-
-    /** @notes 幂等写入当前通话的已完成转写分段 */
-    public function upsertCallTranscriptSegments()
-    {
-        $params = $this->request->post();
-        $params['admin_id'] = (int)$this->adminId;
-        $result = DiagnosisLogic::upsertCallTranscriptSegments($params);
-        if ($result === false) {
-            return $this->fail(DiagnosisLogic::getError());
-        }
-        return $this->data($result);
-    }
-
-    /** @notes 完成当前通话转写并固化对话文字 */
-    public function finishCallTranscription()
-    {
-        $params = $this->request->post();
-        $params['admin_id'] = (int)$this->adminId;
-        $result = DiagnosisLogic::finishCallTranscription($params);
-        if ($result === false) {
-            return $this->fail(DiagnosisLogic::getError());
-        }
-        return $this->data($result);
-    }
-    
+
+        $result = DiagnosisLogic::startCall($params, $this->adminInfo);
+        if ($result !== false) {
+            return $this->data($result);
+        }
+        return $this->fail(DiagnosisLogic::getError());
+    }
+
+    /** @notes 为当前医生的指定通话记录启动实时录音转写 */
+    public function startCallTranscription()
+    {
+        $params = $this->request->post();
+        $params['admin_id'] = (int)$this->adminId;
+        $result = DiagnosisLogic::startCallTranscription($params);
+        if ($result === false) {
+            return $this->fail(DiagnosisLogic::getError());
+        }
+        return $this->data($result);
+    }
+
+    /** @notes 幂等写入当前通话的已完成转写分段 */
+    public function upsertCallTranscriptSegments()
+    {
+        $params = $this->request->post();
+        $params['admin_id'] = (int)$this->adminId;
+        $result = DiagnosisLogic::upsertCallTranscriptSegments($params);
+        if ($result === false) {
+            return $this->fail(DiagnosisLogic::getError());
+        }
+        return $this->data($result);
+    }
+
+    /** @notes 完成当前通话转写并固化对话文字 */
+    public function finishCallTranscription()
+    {
+        $params = $this->request->post();
+        $params['admin_id'] = (int)$this->adminId;
+        $result = DiagnosisLogic::finishCallTranscription($params);
+        if ($result === false) {
+            return $this->fail(DiagnosisLogic::getError());
+        }
+        return $this->data($result);
+    }
+
     /**
      * @notes 结束通话
      * @return \think\response\Json
@@ -411,21 +413,21 @@ class DiagnosisController extends BaseAdminController
     public function endCall()
     {
         $params = $this->request->post();
-        
+
         if (empty($params['diagnosis_id'])) {
             return $this->fail('诊单ID不能为空');
         }
-        
+
         // 传递当前管理员ID
         $params['admin_id'] = $this->adminId;
-        
+
         $result = DiagnosisLogic::endCall($params);
         if ($result) {
             return $this->success('', [], 1, 1);
         }
         return $this->fail(DiagnosisLogic::getError());
     }
-    
+
     /**
      * @notes 获取通话记录
      * @return \think\response\Json
@@ -433,11 +435,11 @@ class DiagnosisController extends BaseAdminController
     public function getCallRecords()
     {
         $params = $this->request->get();
-        
+
         if (empty($params['diagnosis_id'])) {
             return $this->fail('诊单ID不能为空');
         }
-        
+
         $result = DiagnosisLogic::getCallRecords($params);
         return $this->data($result);
     }
@@ -603,11 +605,11 @@ class DiagnosisController extends BaseAdminController
     public function getDoctorSignature()
     {
         $params = $this->request->get();
-        
+
         if (empty($params['patient_id'])) {
             return $this->fail('医助理ID不能为空');
         }
-        
+
         $result = DiagnosisLogic::getDoctorSignature((int)$params['patient_id']);
         if ($result) {
             return $this->data($result);
@@ -621,18 +623,18 @@ class DiagnosisController extends BaseAdminController
     public function getPatientSignature()
     {
         $params = $this->request->get();
-        
+
         if (empty($params['patient_id'])) {
             return $this->fail('患者ID不能为空');
         }
-        
+
         $result = DiagnosisLogic::getPatientSignature((int)$params['patient_id']);
         if ($result) {
             return $this->data($result);
         }
         return $this->fail(DiagnosisLogic::getError());
     }
-    
+
     /**
      * @notes 获取医助列表
      * @return \think\response\Json
@@ -642,7 +644,7 @@ class DiagnosisController extends BaseAdminController
         $result = DiagnosisLogic::getAssistants((int) $this->adminId, $this->adminInfo);
         return $this->data($result);
     }
-    
+
     /**
      * @notes 获取医生列表
      * @return \think\response\Json
@@ -652,7 +654,7 @@ class DiagnosisController extends BaseAdminController
         $result = DiagnosisLogic::getDoctors();
         return $this->data($result);
     }
-    
+
     /**
      * @notes 生成小程序码
      * @return \think\response\Json
@@ -824,7 +826,7 @@ class DiagnosisController extends BaseAdminController
         }
 
         $offset = ($page_no - 1) * $page_size;
-        
+
         $lists = \app\common\model\tcm\Diagnosis::where('patient_name|phone|id_card', 'like', '%' . $keyword . '%')
             ->field(['id', 'patient_name', 'phone', 'id_card', 'gender', 'age'])
             ->limit($offset, $page_size)
@@ -842,4 +844,129 @@ class DiagnosisController extends BaseAdminController
             'page_size' => $page_size
         ]);
     }
+
+    /**
+     * @notes 读取已保存的双模型诊单 AI 报告，不触发上游调用
+     */
+    public function aiReports()
+    {
+        $params = (new DiagnosisValidate())->get()->goCheck('aiReports');
+        $reports = DiagnosisAiLogic::getSavedReports(
+            (int) $params['id'],
+            $this->adminId,
+            $this->adminInfo
+        );
+        if ($reports === null) {
+            return $this->fail(DiagnosisAiLogic::getError());
+        }
+        return $this->data($reports);
+    }
+
+    /**
+     * @notes 基于当前授权诊单向 AI 助手提问，不接收客户端上游配置
+     */
+    public function aiAssistant()
+    {
+        $params = (new DiagnosisValidate())->post()->goCheck('aiAssistant');
+        $result = DiagnosisAiLogic::assistant(
+            (int) $params['id'],
+            (string) $params['task'],
+            (string) ($params['prompt'] ?? ''),
+            $this->adminId,
+            $this->adminInfo
+        );
+        if ($result === null) {
+            return $this->fail(DiagnosisAiLogic::getError());
+        }
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 对当前授权诊单生成一次结构化 AI 智能分析，仅接受 qwen/openai 模型键
+     */
+    public function aiAnalysis()
+    {
+        $params = (new DiagnosisValidate())->post()->goCheck('aiAnalysis');
+        $result = DiagnosisAiLogic::analysis(
+            (int) $params['id'],
+            $this->adminId,
+            $this->adminInfo,
+            (string) ($params['model'] ?? 'qwen')
+        );
+        if ($result === null) {
+            return $this->fail(DiagnosisAiLogic::getError());
+        }
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 查询患者级 AI 诊断报告全部历史及各模型最新版本，不触发模型调用
+     */
+    public function patientAiReports()
+    {
+        $params = (new DiagnosisValidate())->get()->goCheck('patientAiReports');
+        $result = PatientAiReportLogic::reports(
+            (int) $params['patient_id'],
+            $this->adminId,
+            $this->adminInfo
+        );
+        if ($result === null) {
+            return $this->fail(PatientAiReportLogic::getError());
+        }
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 聚合当前数据域内患者纵向资料，调用指定固定模型并新增一份不可变报告快照
+     */
+    public function generatePatientAiReport()
+    {
+        $params = (new DiagnosisValidate())->post()->goCheck('generatePatientAiReport');
+        $result = PatientAiReportLogic::generate(
+            (int) $params['patient_id'],
+            (string) $params['model'],
+            $this->adminId,
+            $this->adminInfo
+        );
+        if ($result === null) {
+            return $this->fail(PatientAiReportLogic::getError());
+        }
+        return $this->data($result);
+    }
+
+    /**
+     * @notes 整份重新生成两个固定模型的诊单 AI 报告并保存成功项
+     */
+    public function generateAiReports()
+    {
+        $params = (new DiagnosisValidate())->post()->goCheck('generateAiReports');
+        $reports = DiagnosisAiLogic::generateAll(
+            (int) $params['id'],
+            $this->adminId,
+            $this->adminInfo
+        );
+        if ($reports === null) {
+            return $this->fail(DiagnosisAiLogic::getError());
+        }
+        return $this->data($reports);
+    }
+
+    /**
+     * @notes 编辑一份已保存的诊单 AI 报告
+     */
+    public function editAiReport()
+    {
+        $params = (new DiagnosisValidate())->post()->goCheck('editAiReport');
+        $report = DiagnosisAiLogic::editReport(
+            (int) $params['id'],
+            (int) $params['report_id'],
+            $params['content'] ?? null,
+            $this->adminId,
+            $this->adminInfo
+        );
+        if ($report === null) {
+            return $this->fail(DiagnosisAiLogic::getError());
+        }
+        return $this->data($report);
+    }
 }

server/app/adminapi/logic/tcm/PrescriptionLibraryAiLogic.php

@@ -198,7 +198,7 @@ class PrescriptionLibraryAiLogic extends BaseLogic
                     'prescription_id' => $id,
                     'model_key' => $modelKey,
                     'admin_id' => $adminId,
-                    'error' => $e->getMessage(),
+                    'exception_class' => get_class($e),
                 ]);
                 $result = [
                     'ok' => false,
@@ -246,7 +246,7 @@ class PrescriptionLibraryAiLogic extends BaseLogic
                     'prescription_id' => $id,
                     'model_key' => $modelKey,
                     'admin_id' => $adminId,
-                    'error' => $e->getMessage(),
+                    'exception_class' => get_class($e),
                 ]);
                 $failureCount++;
                 $results[] = array_merge($resultBase, [

server/app/adminapi/validate/tcm/DiagnosisValidate.php

@@ -45,6 +45,12 @@ class DiagnosisValidate extends BaseValidate
         'diagnosis_id' => 'require|integer|checkDiagnosisId',
         'tracking_content' => 'require|length:1,1000',
         'revisit_slot_start_offset' => 'integer|between:0,20',
+        'report_id' => 'number|gt:0',
+        'content' => 'max:12000',
+        'task' => 'require|in:summary,tcm_pattern,prescription_review,medication_review,exam_review,complication_risk,guideline_review,custom',
+        'prompt' => 'max:500',
+        'model' => 'in:qwen,openai',
+        'patient_id' => 'integer|gt:0',
     ];
 
     protected $message = [
@@ -72,6 +78,18 @@ class DiagnosisValidate extends BaseValidate
         'diagnosis_id.require' => '诊单ID不能为空',
         'tracking_content.require' => '跟踪备注内容不能为空',
         'tracking_content.length' => '跟踪备注最多1000个字符',
+        'report_id.require' => '报告ID不能为空',
+        'report_id.number' => '报告ID必须为数字',
+        'report_id.gt' => '报告ID必须大于0',
+        'content.require' => '报告内容不能为空',
+        'content.max' => '报告内容最多12000个字符',
+        'task.require' => '请选择 AI 助手任务',
+        'task.in' => 'AI 助手任务不受支持',
+        'prompt.max' => '问题最多500个字符',
+        'model.in' => 'AI模型仅支持qwen或openai',
+        'patient_id.require' => '患者ID不能为空',
+        'patient_id.integer' => '患者ID必须为整数',
+        'patient_id.gt' => '患者ID必须大于0',
     ];
 
     public function sceneAdd()
@@ -114,17 +132,17 @@ class DiagnosisValidate extends BaseValidate
         return $this->only(['diagnosis_id']);
     }
 
-    public function sceneGenerateQrcode()
-    {
-        return $this->only(['diagnosis_id', 'doctor_id', 'patient_id', 'share_user_id', 'mini_program_path'])
-            // The global diagnosis_id rule is required for diagnosis APIs, but
-            // video QR codes identify the doctor instead. Keep diagnosis_id
-            // optional here while still validating it when it is supplied.
-            ->remove('diagnosis_id', 'require')
-            ->append('patient_id', 'require|integer|checkQrcodeIds')
-            ->append('share_user_id', 'require|integer')
-            ->append('doctor_id', 'integer');
-    }
+    public function sceneGenerateQrcode()
+    {
+        return $this->only(['diagnosis_id', 'doctor_id', 'patient_id', 'share_user_id', 'mini_program_path'])
+            // The global diagnosis_id rule is required for diagnosis APIs, but
+            // video QR codes identify the doctor instead. Keep diagnosis_id
+            // optional here while still validating it when it is supplied.
+            ->remove('diagnosis_id', 'require')
+            ->append('patient_id', 'require|integer|checkQrcodeIds')
+            ->append('share_user_id', 'require|integer')
+            ->append('doctor_id', 'integer');
+    }
 
     public function sceneGenerateOrderQrcode()
     {
@@ -150,6 +168,48 @@ class DiagnosisValidate extends BaseValidate
             ->append('revisit_slot_start_offset', 'require|integer|between:0,20');
     }
 
+    public function sceneAiReports()
+    {
+        return $this->only(['id']);
+    }
+
+    public function sceneAiAssistant()
+    {
+        return $this->only(['id', 'task', 'prompt']);
+    }
+
+    public function sceneAiAnalysis()
+    {
+        return $this->only(['id', 'model'])
+            ->remove('id', 'checkDiagnosis')
+            ->append('id', 'integer|gt:0|checkAiAnalysisPayload');
+    }
+
+    public function scenePatientAiReports()
+    {
+        return $this->only(['patient_id'])
+            ->append('patient_id', 'require|integer|gt:0|checkPatientAiReportsPayload');
+    }
+
+    public function sceneGeneratePatientAiReport()
+    {
+        return $this->only(['patient_id', 'model'])
+            ->append('patient_id', 'require|integer|gt:0|checkGeneratePatientAiReportPayload')
+            ->append('model', 'require|in:qwen,openai');
+    }
+
+    public function sceneGenerateAiReports()
+    {
+        return $this->only(['id']);
+    }
+
+    public function sceneEditAiReport()
+    {
+        return $this->only(['id', 'report_id', 'content'])
+            ->append('report_id', 'require|number|gt:0')
+            ->append('content', 'require|max:12000');
+    }
+
     protected function checkDiagnosis($value)
     {
         $diagnosis = Diagnosis::findOrEmpty($value);
@@ -183,11 +243,71 @@ class DiagnosisValidate extends BaseValidate
     protected function checkQrcodeIds($value, $rule, $data = [])
     {
         $page = $data['mini_program_path'] ?? '';
-        $hasDoctor = !empty($data['doctor_id']);
+        $hasDoctor = !empty($data['doctor_id']);
         $hasDiagnosis = !empty($data['diagnosis_id']);
         if ($page === 'pages/login/login') {
             return $hasDoctor ? true : '视频二维码需传挂号医生ID';
         }
         return $hasDiagnosis ? true : '诊单ID不能为空';
     }
-}
+
+    /**
+     * AI 智能分析仅接受诊单 ID 和可选的固定模型键。客户端不得提供
+     * provider、凭据、上游地址、提示词等服务端配置或控制字段。
+     *
+     * @param mixed $value
+     * @param mixed $rule
+     * @param array<string,mixed> $data
+     * @return bool|string
+     */
+    protected function checkAiAnalysisPayload($value, $rule, array $data = [])
+    {
+        if (!array_key_exists('id', $data)) {
+            return 'AI智能分析请求缺少id参数';
+        }
+
+        $extraFields = array_diff(array_keys($data), ['id', 'model']);
+        if ($extraFields !== []) {
+            return 'AI智能分析请求仅允许id及可选model参数';
+        }
+
+        if (array_key_exists('model', $data)) {
+            $model = $data['model'];
+            if (!is_string($model) || !in_array($model, ['qwen', 'openai'], true)) {
+                return 'AI模型仅支持qwen或openai';
+            }
+        }
+        return true;
+    }
+
+    /** @param array<string,mixed> $data */
+    protected function checkPatientAiReportsPayload($value, $rule, array $data = [])
+    {
+        if (!array_key_exists('patient_id', $data)) {
+            return '请求缺少patient_id参数';
+        }
+        $extraFields = array_diff(array_keys($data), ['patient_id']);
+        return $extraFields === [] ? true : '请求仅允许patient_id参数';
+    }
+
+    /**
+     * 患者报告生成端点只接受稳定患者ID与服务端模型白名单键。
+     * provider、凭据、BASE_URL、提示词和任意来源正文均不得由客户端注入。
+     *
+     * @param array<string,mixed> $data
+     */
+    protected function checkGeneratePatientAiReportPayload($value, $rule, array $data = [])
+    {
+        if (!array_key_exists('patient_id', $data) || !array_key_exists('model', $data)) {
+            return '请求缺少patient_id或model参数';
+        }
+        $extraFields = array_diff(array_keys($data), ['patient_id', 'model']);
+        if ($extraFields !== []) {
+            return '请求仅允许patient_id和model参数';
+        }
+        if (!is_string($data['model']) || !in_array($data['model'], ['qwen', 'openai'], true)) {
+            return 'AI模型仅支持qwen或openai';
+        }
+        return true;
+    }
+}

server/app/common/model/tcm/DiagnosisAiReport.php

@@ -0,0 +1,17 @@
+<?php
+
+declare(strict_types=1);
+
+namespace app\common\model\tcm;
+
+use app\common\model\BaseModel;
+
+/**
+ * 诊单 AI 报告。
+ */
+class DiagnosisAiReport extends BaseModel
+{
+    protected $name = 'diagnosis_ai_report';
+
+    protected $autoWriteTimestamp = true;
+}

server/app/common/model/tcm/PatientAiReport.php

@@ -0,0 +1,21 @@
+<?php
+
+declare(strict_types=1);
+
+namespace app\common\model\tcm;
+
+use app\common\model\BaseModel;
+
+/**
+ * 患者级 AI 诊断报告快照。
+ *
+ * 每次生成均新增一行；本模型没有更新/覆盖历史报告的业务方法。
+ */
+class PatientAiReport extends BaseModel
+{
+    protected $name = 'patient_ai_report';
+
+    protected $autoWriteTimestamp = false;
+
+    protected $dateFormat = false;
+}

server/app/common/service/DifyChatService.php

@@ -5,12 +5,20 @@ declare(strict_types=1);
 namespace app\common\service;
 
 /**
- * Dify Chat App blocking 客户端。
+ * 处方/诊单 AI 上游客户端。
  *
- * 只接受服务端配置中的模型 profile，避免把上游地址和密钥暴露给前端。
+ * 兼容 Dify blocking chat-messages 与 OpenAI-compatible chat completions。
+ * 地址和凭据只从服务端 prescription_ai 配置读取，不进入响应、日志或请求正文。
  */
 class DifyChatService
 {
+    /** @var array<int,string> */
+    private const ALLOWED_PROFILES = ['qwen', 'openai'];
+
+    private const MIN_TIMEOUT = 1;
+
+    private const MAX_TIMEOUT = 300;
+
     /**
      * @param array<string,mixed> $inputs
      * @return array{ok:bool,content?:string,message_id?:string,latency_ms?:int,error_code?:string,error?:string}
@@ -19,45 +27,197 @@ class DifyChatService
     {
         $config = config('prescription_ai') ?: [];
         if (empty($config['enable'])) {
-            return self::error('CONFIG_DISABLED', '处方 AI 解释未启用');
+            return self::error('CONFIG_DISABLED', 'AI 报告功能未启用');
         }
 
-        $modelConfig = $config['models'][$profile] ?? null;
-        if (!is_array($modelConfig)) {
+        $modelConfig = self::resolveProfileConfig($config, $profile);
+        if ($modelConfig === null) {
             return self::error('INVALID_PROFILE', '不支持的 AI 模型');
         }
 
         $baseUrl = trim((string) ($config['base_url'] ?? ''));
-        $apiKey = trim((string) ($modelConfig['api_key'] ?? ''));
+        $rawApiKey = (string) ($modelConfig['api_key'] ?? '');
+        $apiKey = trim($rawApiKey);
         if ($baseUrl === '' || $apiKey === '') {
-            return self::error('CONFIG_MISSING', '该模型尚未配置 Dify 地址或 App Key');
+            return self::error('CONFIG_MISSING', '该模型服务尚未完整配置');
+        }
+        if (!self::isValidBaseUrl($baseUrl) || strpbrk($rawApiKey, "\r\n") !== false) {
+            return self::error('CONFIG_INVALID', 'AI 服务配置无效');
+        }
+
+        $timeout = (int) ($config['timeout'] ?? 0);
+        if (!self::isValidTimeout($timeout)) {
+            return self::error('CONFIG_INVALID', 'AI 服务超时配置无效');
         }
         if (!function_exists('curl_init')) {
             return self::error('CURL_UNAVAILABLE', '服务器尚未启用 cURL 扩展');
         }
 
-        $payload = [
-            'inputs' => $inputs,
-            'query' => $query,
-            'response_mode' => 'blocking',
-            'user' => $user,
+        $model = trim((string) ($modelConfig['name'] ?? ''));
+        if ($model === '') {
+            return self::error('CONFIG_INVALID', 'AI 模型配置无效');
+        }
+
+        $requestSpecs = self::buildRequestSpecs($baseUrl, $model, $inputs, $query, $user);
+        $startedAt = microtime(true);
+        $lastResponse = null;
+
+        foreach ($requestSpecs as $index => $requestSpec) {
+            $elapsedSeconds = (int) floor(microtime(true) - $startedAt);
+            $remainingTimeout = $timeout - $elapsedSeconds;
+            if ($remainingTimeout < self::MIN_TIMEOUT) {
+                return self::error(
+                    'UPSTREAM_TIMEOUT',
+                    '模型响应超时，请稍后重试',
+                    self::elapsedMilliseconds($startedAt)
+                );
+            }
+
+            $response = self::sendRequest(
+                $requestSpec['url'],
+                $requestSpec['payload'],
+                $apiKey,
+                $remainingTimeout
+            );
+            $lastResponse = $response;
+
+            // /v1 在两种协议中都是合法基址。仅在明确表示路径不存在时尝试另一协议，
+            // 避免因业务参数错误而重复提交同一份临床数据。
+            $hasFallback = isset($requestSpecs[$index + 1]);
+            if ($hasFallback && in_array($response['http_code'], [404, 405], true)) {
+                continue;
+            }
+
+            return self::formatResponse($response, $startedAt);
+        }
+
+        return self::formatResponse($lastResponse ?? [
+            'body' => '',
+            'errno' => 0,
+            'http_code' => 0,
+        ], $startedAt);
+    }
+
+    /**
+     * @param array<string,mixed> $config
+     * @return array<string,mixed>|null
+     */
+    private static function resolveProfileConfig(array $config, string $profile): ?array
+    {
+        if (!in_array($profile, self::ALLOWED_PROFILES, true)) {
+            return null;
+        }
+        $modelConfig = $config['models'][$profile] ?? null;
+        return is_array($modelConfig) ? $modelConfig : null;
+    }
+
+    /**
+     * @param array<string,mixed> $inputs
+     * @return array<int,array{protocol:string,url:string,payload:array<string,mixed>}>
+     */
+    private static function buildRequestSpecs(
+        string $baseUrl,
+        string $model,
+        array $inputs,
+        string $query,
+        string $user
+    ): array {
+        $baseUrl = rtrim($baseUrl, '/');
+        $path = strtolower((string) (parse_url($baseUrl, PHP_URL_PATH) ?? ''));
+
+        $difySpec = [
+            'protocol' => 'dify',
+            'url' => self::buildEndpoint($baseUrl, 'chat-messages'),
+            'payload' => [
+                'inputs' => $inputs,
+                'query' => $query,
+                'response_mode' => 'blocking',
+                'user' => $user,
+            ],
         ];
+        $openAiSpec = [
+            'protocol' => 'openai',
+            'url' => self::buildEndpoint($baseUrl, 'chat/completions'),
+            'payload' => [
+                'model' => $model,
+                'messages' => [
+                    ['role' => 'user', 'content' => $query],
+                ],
+            ],
+        ];
+
+        if (str_ends_with($path, '/chat-messages')) {
+            return [$difySpec];
+        }
+        if (str_ends_with($path, '/chat/completions')) {
+            return [$openAiSpec];
+        }
+
+        // 保持既有 /v1 Dify 配置优先，同时让 OpenAI-compatible 服务在 404/405 后透明回退。
+        return [$difySpec, $openAiSpec];
+    }
+
+    private static function buildEndpoint(string $baseUrl, string $endpoint): string
+    {
+        $baseUrl = rtrim($baseUrl, '/');
+        $path = strtolower((string) (parse_url($baseUrl, PHP_URL_PATH) ?? ''));
+        if (str_ends_with($path, '/chat-messages') || str_ends_with($path, '/chat/completions')) {
+            return $baseUrl;
+        }
+        if (str_ends_with($path, '/v1')) {
+            return $baseUrl . '/' . $endpoint;
+        }
+        return $baseUrl . '/v1/' . $endpoint;
+    }
+
+    private static function isValidBaseUrl(string $baseUrl): bool
+    {
+        if (preg_match('/[\x00-\x20\x7f]/', $baseUrl)) {
+            return false;
+        }
+        $parts = parse_url($baseUrl);
+        if (!is_array($parts)) {
+            return false;
+        }
+        $scheme = strtolower((string) ($parts['scheme'] ?? ''));
+        return in_array($scheme, ['http', 'https'], true)
+            && trim((string) ($parts['host'] ?? '')) !== ''
+            && !isset($parts['user'])
+            && !isset($parts['pass'])
+            && !isset($parts['query'])
+            && !isset($parts['fragment']);
+    }
+
+    private static function isValidTimeout(int $timeout): bool
+    {
+        return $timeout >= self::MIN_TIMEOUT && $timeout <= self::MAX_TIMEOUT;
+    }
+
+    /**
+     * @param array<string,mixed> $payload
+     * @return array{body:string,errno:int,http_code:int}
+     */
+    private static function sendRequest(
+        string $url,
+        array $payload,
+        string $apiKey,
+        int $timeout
+    ): array {
         $body = json_encode($payload, JSON_UNESCAPED_UNICODE | JSON_INVALID_UTF8_SUBSTITUTE);
         if ($body === false) {
-            return self::error('REQUEST_BUILD_FAILED', '处方数据编码失败');
+            return ['body' => '', 'errno' => -1, 'http_code' => 0];
         }
 
-        $timeout = max(10, min(120, (int) ($config['timeout'] ?? 90)));
         $ch = curl_init();
         if ($ch === false) {
-            return self::error('CURL_INIT_FAILED', '无法初始化 AI 请求');
+            return ['body' => '', 'errno' => -2, 'http_code' => 0];
         }
         curl_setopt_array($ch, [
-            CURLOPT_URL => self::buildEndpoint($baseUrl),
+            CURLOPT_URL => $url,
             CURLOPT_POST => true,
             CURLOPT_POSTFIELDS => $body,
             CURLOPT_RETURNTRANSFER => true,
-            CURLOPT_CONNECTTIMEOUT => min(8, max(3, (int) ceil($timeout / 4))),
+            CURLOPT_CONNECTTIMEOUT => min(8, max(1, (int) ceil($timeout / 4))),
             CURLOPT_TIMEOUT => $timeout,
             CURLOPT_SSL_VERIFYPEER => true,
             CURLOPT_SSL_VERIFYHOST => 2,
@@ -68,35 +228,56 @@ class DifyChatService
             ],
         ]);
 
-        $startedAt = microtime(true);
         $responseBody = curl_exec($ch);
         $errno = curl_errno($ch);
         $httpCode = (int) curl_getinfo($ch, CURLINFO_HTTP_CODE);
         curl_close($ch);
-        $latencyMs = (int) round((microtime(true) - $startedAt) * 1000);
+
+        return [
+            'body' => is_string($responseBody) ? $responseBody : '',
+            'errno' => $errno,
+            'http_code' => $httpCode,
+        ];
+    }
+
+    /**
+     * @param array{body:string,errno:int,http_code:int} $response
+     * @return array{ok:bool,content?:string,message_id?:string,latency_ms:int,error_code?:string,error?:string}
+     */
+    private static function formatResponse(array $response, float $startedAt): array
+    {
+        $latencyMs = self::elapsedMilliseconds($startedAt);
+        $errno = $response['errno'];
+        $httpCode = $response['http_code'];
 
         if ($errno !== 0) {
             if ($errno === CURLE_OPERATION_TIMEDOUT) {
                 return self::error('UPSTREAM_TIMEOUT', '模型响应超时，请稍后重试', $latencyMs);
             }
+            if ($errno === -1) {
+                return self::error('REQUEST_BUILD_FAILED', '病例数据编码失败', $latencyMs);
+            }
+            if ($errno === -2) {
+                return self::error('CURL_INIT_FAILED', '无法初始化 AI 请求', $latencyMs);
+            }
             return self::error('UPSTREAM_UNAVAILABLE', '暂时无法连接 AI 服务，请稍后重试', $latencyMs);
         }
 
-        $decoded = json_decode((string) $responseBody, true);
+        $decoded = json_decode($response['body'], true);
         if ($httpCode === 401 || $httpCode === 403) {
-            return self::error('CONFIG_INVALID', '模型 App Key 无效或无权限', $latencyMs);
+            return self::error('CONFIG_INVALID', 'AI 服务凭据无效或无权限', $latencyMs);
         }
         if ($httpCode === 429 || $httpCode >= 500) {
             return self::error('UPSTREAM_BUSY', '模型服务繁忙，请稍后重试', $latencyMs);
         }
-        if ($httpCode >= 400) {
+        if ($httpCode >= 400 || $httpCode < 200) {
             return self::error('UPSTREAM_REJECTED', '模型未能处理本次请求', $latencyMs);
         }
         if (!is_array($decoded)) {
             return self::error('INVALID_RESPONSE', '模型返回格式异常，请重试', $latencyMs);
         }
 
-        $answer = trim((string) ($decoded['answer'] ?? ''));
+        $answer = self::extractContent($decoded);
         if ($answer === '') {
             return self::error('EMPTY_RESPONSE', '模型未返回报告内容，请重试', $latencyMs);
         }
@@ -104,21 +285,34 @@ class DifyChatService
         return [
             'ok' => true,
             'content' => $answer,
-            'message_id' => (string) ($decoded['message_id'] ?? ''),
+            'message_id' => (string) ($decoded['message_id'] ?? $decoded['id'] ?? ''),
             'latency_ms' => $latencyMs,
         ];
     }
 
-    private static function buildEndpoint(string $baseUrl): string
+    /** @param array<string,mixed> $decoded */
+    private static function extractContent(array $decoded): string
     {
-        $baseUrl = rtrim($baseUrl, '/');
-        if (str_ends_with($baseUrl, '/chat-messages')) {
-            return $baseUrl;
+        $content = $decoded['answer'] ?? $decoded['choices'][0]['message']['content'] ?? '';
+        if (is_string($content)) {
+            return trim($content);
         }
-        if (str_ends_with($baseUrl, '/v1')) {
-            return $baseUrl . '/chat-messages';
+        if (!is_array($content)) {
+            return '';
         }
-        return $baseUrl . '/v1/chat-messages';
+
+        $parts = [];
+        foreach ($content as $part) {
+            if (is_array($part) && ($part['type'] ?? '') === 'text' && is_string($part['text'] ?? null)) {
+                $parts[] = $part['text'];
+            }
+        }
+        return trim(implode('', $parts));
+    }
+
+    private static function elapsedMilliseconds(float $startedAt): int
+    {
+        return (int) round((microtime(true) - $startedAt) * 1000);
     }
 
     /**