feat(medications): 添加用药AI总结功能，支持生成用户用药计划的重点解读

sql-scripts/2025-01-18-medication-ai-summaries-table.sql

@@ -0,0 +1,20 @@
+-- 用药 AI 总结表创建脚本
+-- 创建时间: 2025-01-18
+-- 说明: 按天存储用户的用药AI总结，避免重复调用大模型
+
+CREATE TABLE IF NOT EXISTS `t_medication_ai_summaries` (
+  `id` varchar(50) NOT NULL COMMENT '唯一标识',
+  `user_id` varchar(50) NOT NULL COMMENT '用户ID',
+  `summary_date` date NOT NULL COMMENT '统计日期（YYYY-MM-DD）',
+  `medication_analysis` json NOT NULL COMMENT '用药计划与进度统计',
+  `key_insights` text NOT NULL COMMENT 'AI重点解读',
+  `created_at` datetime NOT NULL DEFAULT CURRENT_TIMESTAMP COMMENT '创建时间',
+  `updated_at` datetime NOT NULL DEFAULT CURRENT_TIMESTAMP ON UPDATE CURRENT_TIMESTAMP COMMENT '更新时间',
+  PRIMARY KEY (`id`),
+  UNIQUE KEY `uq_user_date` (`user_id`, `summary_date`),
+  KEY `idx_user_date` (`user_id`, `summary_date`)
+) ENGINE=InnoDB DEFAULT CHARSET=utf8mb4 COLLATE=utf8mb4_unicode_ci COMMENT='用药AI总结表（按天缓存）';
+
+-- 使用说明：
+-- 1) 每位用户每日最多一条记录，用于缓存当天的用药AI总结。
+-- 2) medication_analysis 字段存储 JSON 数组（medicationAnalysis 列表），key_insights 存储生成的重点解读文本。

src/medications/dto/medication-ai-summary.dto.ts

@@ -0,0 +1,41 @@
+import { ApiProperty } from '@nestjs/swagger';
+
+export class MedicationPlanItemDto {
+  @ApiProperty({ description: '药物ID' })
+  id: string;
+
+  @ApiProperty({ description: '药物名称' })
+  name: string;
+
+  @ApiProperty({ description: '开始服药日期（YYYY-MM-DD）' })
+  startDate: string;
+
+  @ApiProperty({ description: '计划统计的天数（从开始日期到今天或计划结束日期，未来开始则为0）' })
+  plannedDays: number;
+
+  @ApiProperty({ description: '计划每日服药次数' })
+  timesPerDay: number;
+
+  @ApiProperty({ description: '计划总服药次数（plannedDays * timesPerDay）' })
+  plannedDoses: number;
+
+  @ApiProperty({ description: '已打卡完成的次数' })
+  takenDoses: number;
+
+  @ApiProperty({ description: '完成率（0-1之间的小数，保留两位）', example: 0.82 })
+  completionRate: number;
+}
+
+export class MedicationAiSummaryDto {
+  @ApiProperty({
+    description: '当前正在服用的药物列表',
+    type: [MedicationPlanItemDto],
+  })
+  medicationAnalysis: MedicationPlanItemDto[];
+
+  @ApiProperty({
+    description: 'AI 针对当前用药搭配的重点解读（200字以内）',
+    example: '当前方案以控制炎症与镇痛为主，请留意胃肠不适并按时复诊，避免自行叠加非甾体药物，如出现头晕或皮疹需及时就医。',
+  })
+  keyInsights: string;
+}

src/medications/medications.controller.ts

@@ -27,6 +27,7 @@ import { MedicationRecognitionService } from './services/medication-recognition.
 import { UsersService } from '../users/users.service';
 import { RepeatPatternEnum } from './enums/repeat-pattern.enum';
 import { RecognitionStatusEnum } from './enums/recognition-status.enum';
+import { MedicationAiSummaryDto } from './dto/medication-ai-summary.dto';
 
 /**
  * 药物管理控制器
@@ -83,6 +84,60 @@ export class MedicationsController {
     return ApiResponseDto.success(result, '查询成功');
   }
 
+  @Get('ai-summary')
+  @ApiOperation({
+    summary: '获取用药AI总结',
+    description: '汇总当前开启的用药计划，并生成200字以内的专业搭配建议',
+  })
+  @ApiResponse({
+    status: 200,
+    description: '获取成功',
+    type: MedicationAiSummaryDto,
+  })
+  @ApiResponse({
+    status: 403,
+    description: '免费使用次数已用完',
+  })
+  async getMedicationAiSummary(@CurrentUser() user: any) {
+    try {
+      const cached = await this.analysisService.getTodaySummaryIfExists(user.sub);
+      if (cached) {
+        return ApiResponseDto.success(cached, '获取成功（缓存）');
+      }
+
+      const userUsageCount = await this.usersService.getUserUsageCount(user.sub);
+      if (userUsageCount <= 0) {
+        this.logger.warn(`用药AI总结失败 - 用户ID: ${user.sub}, 免费次数不足`);
+        return ApiResponseDto.error('免费使用次数已用完，请开通会员获取更多使用次数', 403);
+      }
+
+      const summary = await this.analysisService.summarizeActiveMedications(user.sub);
+
+      // 只有在实际调用大模型时才扣减次数（有开启的用药计划）
+      if (summary.medicationAnalysis.length > 0) {
+        try {
+          await this.usersService.deductUserUsageCount(user.sub, 1);
+          this.logger.log(
+            `用药AI总结成功，已扣减用户免费次数 - 用户ID: ${user.sub}, 剩余次数: ${userUsageCount - 1}`,
+          );
+        } catch (deductError) {
+          this.logger.error(
+            `扣减用户免费次数失败 - 用户ID: ${user.sub}, 错误: ${deductError instanceof Error ? deductError.message : String(deductError)}`,
+          );
+        }
+      }
+
+      return ApiResponseDto.success(summary, '获取成功');
+    } catch (error) {
+      this.logger.error(
+        `获取用药AI总结失败 - 用户ID: ${user.sub}, 错误: ${error instanceof Error ? error.message : String(error)}`,
+      );
+      return ApiResponseDto.error(
+        error instanceof Error ? error.message : '获取AI总结失败',
+      );
+    }
+  }
+
   @Get(':id')
   @ApiOperation({ summary: '获取药物详情' })
   @ApiResponse({ status: 200, description: '查询成功' })
@@ -402,4 +457,4 @@ export class MedicationsController {
       );
     }
   }
-}
+}

src/medications/medications.module.ts

@@ -7,6 +7,7 @@ import { ConfigModule } from '@nestjs/config';
 import { Medication } from './models/medication.model';
 import { MedicationRecord } from './models/medication-record.model';
 import { MedicationRecognitionTask } from './models/medication-recognition-task.model';
+import { MedicationAiSummary } from './models/medication-ai-summary.model';
 
 // Controllers
 import { MedicationsController } from './medications.controller';
@@ -38,6 +39,7 @@ import { UsersModule } from '../users/users.module';
       Medication,
       MedicationRecord,
       MedicationRecognitionTask,
+      MedicationAiSummary,
     ]),
     ScheduleModule.forRoot(), // 启用定时任务
     PushNotificationsModule, // 推送通知功能
@@ -64,4 +66,4 @@ import { UsersModule } from '../users/users.module';
     MedicationStatsService,
   ],
 })
-export class MedicationsModule {}
+export class MedicationsModule {}

src/medications/medications.service.ts

@@ -93,6 +93,20 @@ export class MedicationsService {
     return { rows, total: count };
   }
 
+  /**
+   * 获取用户所有正在进行的用药计划
+   */
+  async findActiveMedications(userId: string): Promise<Medication[]> {
+    return this.medicationModel.findAll({
+      where: {
+        userId,
+        isActive: true,
+        deleted: false,
+      },
+      order: [['startDate', 'ASC']],
+    });
+  }
+
   /**
    * 根据ID获取药物详情
    */
@@ -330,4 +344,4 @@ export class MedicationsService {
       `成功批量软删除了 ${affectedCount} 条 ${medication.id} 的记录`,
     );
   }
-}
+}

src/medications/models/medication-ai-summary.model.ts

@@ -0,0 +1,59 @@
+import { Column, Model, Table, DataType, Index } from 'sequelize-typescript';
+
+@Table({
+  tableName: 't_medication_ai_summaries',
+  underscored: true,
+  paranoid: false,
+})
+export class MedicationAiSummary extends Model {
+  @Column({
+    type: DataType.STRING(50),
+    primaryKey: true,
+    comment: '唯一标识',
+  })
+  declare id: string;
+
+  @Index('idx_user_date')
+  @Column({
+    type: DataType.STRING(50),
+    allowNull: false,
+    comment: '用户ID',
+  })
+  declare userId: string;
+
+  @Index('idx_user_date')
+  @Column({
+    type: DataType.DATEONLY,
+    allowNull: false,
+    comment: '统计日期（YYYY-MM-DD）',
+  })
+  declare summaryDate: string;
+
+  @Column({
+    type: DataType.JSON,
+    allowNull: false,
+    comment: '用药计划与进度统计',
+  })
+  declare medicationAnalysis: any;
+
+  @Column({
+    type: DataType.TEXT,
+    allowNull: false,
+    comment: 'AI重点解读',
+  })
+  declare keyInsights: string;
+
+  @Column({
+    type: DataType.DATE,
+    defaultValue: DataType.NOW,
+    comment: '创建时间',
+  })
+  declare createdAt: Date;
+
+  @Column({
+    type: DataType.DATE,
+    defaultValue: DataType.NOW,
+    comment: '更新时间',
+  })
+  declare updatedAt: Date;
+}

src/medications/services/medication-analysis.service.ts

@@ -3,10 +3,20 @@ import { ConfigService } from '@nestjs/config';
 import { InjectModel } from '@nestjs/sequelize';
 import { OpenAI } from 'openai';
 import { Readable } from 'stream';
+import * as dayjs from 'dayjs';
+import { Op } from 'sequelize';
 import { UsersService } from '../../users/users.service';
 import { MedicationsService } from '../medications.service';
 import { Medication } from '../models/medication.model';
+import { MedicationRecord } from '../models/medication-record.model';
+import { MedicationAiSummary } from '../models/medication-ai-summary.model';
+import { MedicationStatusEnum } from '../enums/medication-status.enum';
 import { AiAnalysisResultDto } from '../dto/ai-analysis-result.dto';
+import {
+  MedicationAiSummaryDto,
+  MedicationPlanItemDto,
+} from '../dto/medication-ai-summary.dto';
+import { v4 as uuidv4 } from 'uuid';
 
 interface LanguageConfig {
   label: string;
@@ -32,6 +42,10 @@ export class MedicationAnalysisService {
     private readonly usersService: UsersService,
     @InjectModel(Medication)
     private readonly medicationModel: typeof Medication,
+    @InjectModel(MedicationRecord)
+    private readonly recordModel: typeof MedicationRecord,
+    @InjectModel(MedicationAiSummary)
+    private readonly summaryModel: typeof MedicationAiSummary,
   ) {
     // GLM-4.5V Configuration
     const glmApiKey = this.configService.get<string>('GLM_API_KEY');
@@ -115,6 +129,124 @@ export class MedicationAnalysisService {
     }
   }
 
+  /**
+   * 获取当日已生成的用药总结（若存在缓存）
+   */
+  async getTodaySummaryIfExists(userId: string): Promise<MedicationAiSummaryDto | null> {
+    const summaryDate = dayjs().format('YYYY-MM-DD');
+    return this.getCachedSummary(userId, summaryDate);
+  }
+
+  /**
+   * 总结用户当前所有开启的用药方案，并生成AI重点解读
+   * @param userId 用户ID
+   */
+  async summarizeActiveMedications(userId: string): Promise<MedicationAiSummaryDto> {
+    const summaryDate = dayjs().format('YYYY-MM-DD');
+    const summaryDay = dayjs(summaryDate);
+    const today = summaryDay.endOf('day');
+    const cached = await this.getCachedSummary(userId, summaryDate);
+    if (cached) {
+      this.logger.log(`命中用药AI总结缓存 - 用户ID: ${userId}, 日期: ${summaryDate}`);
+      return cached;
+    }
+
+    const activeMedications = await this.medicationsService.findActiveMedications(
+      userId,
+    );
+
+    const medicationAnalysis: MedicationPlanItemDto[] = await Promise.all(
+      activeMedications.map(async (medication) => {
+        const startDate = dayjs(medication.startDate).startOf('day');
+        const planEnd = medication.endDate
+          ? dayjs(medication.endDate).endOf('day')
+          : today;
+        const effectiveEnd = planEnd.isAfter(today) ? today : planEnd;
+
+        // 未来开始的计划，天数与计划剂量均为0
+        const plannedDays = startDate.isAfter(effectiveEnd)
+          ? 0
+          : Math.max(effectiveEnd.diff(startDate, 'day') + 1, 0);
+        const plannedDoses = plannedDays * medication.timesPerDay;
+
+        // 统计已完成的打卡次数（只统计 TAKEN）
+        let takenDoses = 0;
+        if (plannedDoses > 0) {
+          takenDoses = await this.recordModel.count({
+            where: {
+              medicationId: medication.id,
+              userId,
+              deleted: false,
+              status: MedicationStatusEnum.TAKEN,
+              scheduledTime: {
+                [Op.between]: [startDate.toDate(), effectiveEnd.toDate()],
+              },
+            },
+          });
+        }
+
+        const completionRate =
+          plannedDoses > 0
+            ? Math.round((takenDoses / plannedDoses) * 100) / 100
+            : 0;
+
+        return {
+          id: medication.id,
+          name: medication.name,
+          startDate: startDate.format('YYYY-MM-DD'),
+          plannedDays,
+          timesPerDay: medication.timesPerDay,
+          plannedDoses,
+          takenDoses,
+          completionRate,
+        };
+      }),
+    );
+
+    this.logger.log(
+      `用户 ${userId} 的用药计划分析结果: ${JSON.stringify(medicationAnalysis, null, 2)}`,
+    );
+
+    // 没有开启的用药计划时，不调用大模型
+    if (!medicationAnalysis.length) {
+      const result = {
+        medicationAnalysis,
+        keyInsights: '当前没有开启的用药计划，请先添加或激活用药后再查看解读。',
+      };
+      await this.saveSummary(userId, summaryDate, result);
+      return result;
+    }
+
+    const prompt = this.buildMedicationSummaryPrompt(medicationAnalysis);
+
+    try {
+      const response = await this.client.chat.completions.create({
+        model: this.model,
+        temperature: 0.4,
+        messages: [
+          {
+            role: 'user',
+            content: prompt,
+          },
+        ],
+      });
+
+      const keyInsights = response.choices?.[0]?.message?.content?.trim() || '';
+      const result: MedicationAiSummaryDto = {
+        medicationAnalysis,
+        keyInsights,
+      };
+
+      await this.saveSummary(userId, summaryDate, result);
+      return result;
+    } catch (error) {
+      this.logger.error(
+        `生成用药总结失败 - 用户ID: ${userId}, 错误: ${error instanceof Error ? error.message : String(error)}`,
+      );
+      throw new Error('生成用药总结失败，请稍后再试');
+    }
+  }
+
   /**
    * 使用视觉模型分析药品（带图片）
    * @param prompt 分析提示
@@ -352,6 +484,82 @@ export class MedicationAnalysisService {
     return readable;
   }
 
+  private async getCachedSummary(
+    userId: string,
+    summaryDate: string,
+  ): Promise<MedicationAiSummaryDto | null> {
+    const record = await this.summaryModel.findOne({
+      where: {
+        userId,
+        summaryDate,
+      },
+    });
+
+    if (!record) {
+      return null;
+    }
+
+    return {
+      medicationAnalysis: record.medicationAnalysis,
+      keyInsights: record.keyInsights,
+    };
+  }
+
+  private async saveSummary(
+    userId: string,
+    summaryDate: string,
+    summary: MedicationAiSummaryDto,
+  ): Promise<void> {
+    try {
+      const existing = await this.summaryModel.findOne({
+        where: { userId, summaryDate },
+      });
+
+      if (existing) {
+        await existing.update({
+          medicationAnalysis: summary.medicationAnalysis,
+          keyInsights: summary.keyInsights,
+        });
+      } else {
+        await this.summaryModel.create({
+          id: uuidv4(),
+          userId,
+          summaryDate,
+          medicationAnalysis: summary.medicationAnalysis,
+          keyInsights: summary.keyInsights,
+        });
+      }
+    } catch (error) {
+      this.logger.error(
+        `保存用药AI总结失败 - 用户ID: ${userId}, 日期: ${summaryDate}, 错误: ${error instanceof Error ? error.message : String(error)}`,
+      );
+    }
+  }
+
+  /**
+   * 构建用药总结的提示词，输出200字以内的重点解读
+   */
+  private buildMedicationSummaryPrompt(
+    medications: MedicationPlanItemDto[],
+  ): string {
+    const medicationList = medications
+      .map(
+        (med, index) =>
+          `${index + 1}）${med.name} | 开始：${med.startDate} | 计划：${med.timesPerDay}次/天，至今共${med.plannedDoses}次 | 已完成：${med.takenDoses}次 | 完成率：${Math.round(med.completionRate * 100)}%`,
+      )
+      .join('\n');
+
+    return `你是一名持证的临床医生与药学专家，请基于以下正在进行中的用药方案，输出中文“重点解读”一段话（200字以内），重点围绕计划 vs 实际的执行情况给出建议。
+
+用药列表：
+${medicationList}
+
+写作要求：
+- 口吻：专业、温和、以患者安全为先
+- 内容：结合完成率与计划总次数，点评用药依从性、潜在风险与监测要点（胃肠道、肝肾功能、血压/血糖等），提出需要复诊或调整的建议
+- 形式：只输出一段文字，不要使用列表或分段，不要重复列出药品清单，不要添加免责声明`;
+  }
+
   /**
    * 构建专业医药分析提示
    * @param medication 药品信息