更新

2026-06-03 14:20:51 +08:00
parent ec4e0b9f29
commit df65344d8f
6 changed files with 619 additions and 16 deletions
@@ -21,6 +21,7 @@ use app\api\logic\tcm\DailyFamilyLikeLogic;
 use app\api\logic\tcm\DailyShareLogic;
 use app\api\logic\tcm\DailyPhoneLogic;
 use app\api\logic\tcm\DailyDietAiLogic;
+use app\api\logic\tcm\DailyBloodCareAiLogic;
 use app\adminapi\logic\ConfigLogic;
 use app\common\model\tcm\Diagnosis;
 use app\common\model\tcm\BloodRecord;
@@ -929,6 +930,47 @@ class TcmController extends BaseApiController
        });
    }

+    /**
+     * @notes 日常记录-AI 血糖照护建议（累计 7 天有记录）
+     *
+     * 路由：GET /api/tcm/dailyBloodCareAiRecommend?diagnosis_id=:id&refresh=0|1
+     */
+    public function dailyBloodCareAiRecommend()
+    {
+        $diagnosisId = (int) $this->request->get('diagnosis_id', 0);
+        $check       = $this->ensurePatientOwnsDiagnosis($diagnosisId);
+        if (!$check['ok']) {
+            return $this->fail($check['error']);
+        }
+
+        $refresh = (int) $this->request->get('refresh', 0) === 1;
+        $result  = DailyBloodCareAiLogic::getDailyCarePlan($diagnosisId, $refresh);
+        if (empty($result['ok'])) {
+            return $this->fail($result['error'] ?? '获取照护建议失败');
+        }
+
+        return $this->data($result['data']);
+    }
+
+    /**
+     * @notes 日常记录-AI 血糖照护建议（SSE 流式）
+     *
+     * 路由：GET /api/tcm/dailyBloodCareAiRecommendStream?diagnosis_id=:id&refresh=0|1
+     */
+    public function dailyBloodCareAiRecommendStream()
+    {
+        $diagnosisId = (int) $this->request->get('diagnosis_id', 0);
+        $check       = $this->ensurePatientOwnsDiagnosis($diagnosisId);
+        if (!$check['ok']) {
+            return $this->fail($check['error']);
+        }
+
+        $refresh = (int) $this->request->get('refresh', 0) === 1;
+        $this->runDailyDietSse(static function (callable $emit) use ($diagnosisId, $refresh): void {
+            DailyBloodCareAiLogic::streamDailyCarePlan($diagnosisId, $refresh, $emit);
+        });
+    }
+
    /**
     * @param callable(callable(string, array<string, mixed>):void):void $runner
     */
@@ -273,6 +273,16 @@ class DailyDietAiLogic
        return $idx;
    }

+    /**
+     * 供血糖照护 AI 等模块复用：患者档案 + 近 7/30 天血糖统计
+     *
+     * @return array{ok:bool,error?:string,data?:array}
+     */
+    public static function getPatientContext(int $diagnosisId): array
+    {
+        return self::buildPatientContext($diagnosisId);
+    }
+
    /**
     * @return array{ok:bool,error?:string,data?:array}
     */
@@ -320,4 +320,68 @@ class GiKnowledge
        $q = trim($q);
        return $q !== '' ? $q : $question;
    }
+
+    /**
+     * 血糖照护 AI 关闭时的规则化方案（监测 + 中医调理方向）
+     *
+     * @param array<string,mixed> $stats7
+     * @param array<string,mixed> $stats30
+     * @param array<string,mixed> $extra syndrome_type, symptoms 等
+     * @return array<string,mixed>
+     */
+    public static function fallbackBloodCarePlan(array $stats7 = [], array $stats30 = [], array $extra = []): array
+    {
+        $exercise   = self::exercisePlan($stats7, $stats30);
+        $level      = (string) ($exercise['level'] ?? 'unknown');
+        $compliance = (int) (($stats30['record_days'] ?? 0) > 0 ? ($stats30['compliance'] ?? 0) : ($stats7['compliance'] ?? 0));
+        $syndrome   = trim((string) ($extra['syndrome_type'] ?? ''));
+        $symptoms   = trim((string) ($extra['symptoms'] ?? ''));
+
+        $summary = match ($level) {
+            'high'   => '近阶段血糖偏高天数偏多，要把监测、饮食和运动一起抓紧，别只靠感觉。',
+            'medium' => '血糖大体可控，但还有波动，坚持记录和餐后活动，能更稳。',
+            'good'   => '近期血糖控制不错，保持现在的节奏，定期复查别松懈。',
+            default  => '先坚持记血糖、看趋势，再按下面几条慢慢调整生活方式。',
+        };
+
+        $bloodAdvice = match ($level) {
+            'high'   => '空腹、餐后都测，偏高那天记下吃了啥、动了没。主食换杂粮、每餐先吃菜和蛋白，甜饮糕点先停。三餐后按上面运动建议动起来，头晕心慌马上停、吃点糖。',
+            'medium' => '每周至少 4 天空腹+餐后配对记录。主食定量、晚餐别过饱，少喝粥配咸菜。餐后散步 20 分钟，睡眠规律，情绪紧张也会抬糖。',
+            'good'   => '保持每周 3–4 次监测即可，注意节假日和串门聚餐别放松。继续低 GI 家常饭，运动别停，体重稳一点更好。',
+            default  => '先把血糖记满 7 天再看趋势。吃饭定时定量，多喝白开水，少甜少油，饭后多走动。',
+        };
+
+        $tcmBase = '消渴病多与肺脾肾气虚、阴虚燥热或痰湿瘀血相关，需结合面诊脉象。';
+        if ($syndrome !== '') {
+            $tcmBase = '就诊辨证倾向「' . $syndrome . '」。';
+        } elseif ($symptoms !== '') {
+            $tcmBase = '结合您登记的症状（' . mb_substr($symptoms, 0, 40) . '…），宜辨证论治。';
+        }
+
+        $tcmPlan = match ($level) {
+            'high'   => $tcmBase . '调理思路：益气养阴、清热生津为主，可配合健脾化湿；食疗如山药、麦冬、桑叶代茶饮方向；艾灸可选足三里、胰俞等穴（需医师指导）。勿自行加大西药或乱用偏方，务必复诊调方。',
+            'medium' => $tcmBase . '调理思路：健脾益气、滋阴润燥，少食肥甘，宜清淡易消化；可配合八段锦、太极拳；中药汤剂需医师面诊后开具，此处不给具体方名剂量。',
+            'good'   => $tcmBase . '调理思路：顾护脾胃、养阴防燥，季节更替注意保暖；维持规律作息与情志舒畅，按医嘱定期复诊即可。',
+            default  => $tcmBase . '建议到中医科面诊，明确证型后再定汤药、针灸方案；平时可饮食清淡、作息规律，配合记录血糖供医师参考。',
+        };
+
+        $watchPoints = match ($level) {
+            'high'   => ['空腹≥7 或餐后明显升高要联系村医', '脚麻脚痛、视力模糊及时就诊', '用药时间饭点别乱改'],
+            'medium' => ['外出走亲也别忘了测糖', '感冒发烧会让血糖乱，多监测', '睡前别加餐太多'],
+            'good'   => ['每 3–6 个月复查糖化血红蛋白', '血压血脂一并管', '家人提醒别擅自停药'],
+            default  => ['坚持每日或隔日记录', '记录与饮食运动一起给大夫看', '不适及时线下就诊'],
+        };
+
+        return [
+            'summary'      => $summary,
+            'blood_advice' => $bloodAdvice,
+            'tcm_plan'     => $tcmPlan,
+            'watch_points' => $watchPoints,
+            'next_steps'   => '下周继续记血糖；饮食可参考本页「AI 饮食建议」；若连续 3 天偏高或出现胸闷脚肿，请尽快线下就诊或视频问诊。',
+            'control_level' => $level,
+            'control_label' => (string) ($exercise['level_label'] ?? ''),
+            'disclaimer'   => '本建议供日常参考，不能替代医师面诊、开方与调药。',
+            'source'       => 'rule',
+        ];
+    }
 }