feat(anesthesia): add preop visit, intraop events, Aldrete scoring, enhance safety check

- AnesthesiaPreopVisit: pre-anesthesia assessment (术前访视)
- AnesthesiaIntraopEvent: intraoperative events (插管/拔管/体位)
- AnesthesiaAldreteScore: PACU Aldrete recovery scoring
- SurgerySafetyCheckController: added @PreAuthorize and phase status/stats endpoints
- Flyway V70 migration for new tables

healthlink-his-server/healthlink-his-application/src/main/java/com/healthlink/his/web/anesthesia/controller/AnesthesiaEnhancedController.java

@@ -1,113 +1,130 @@
 package com.healthlink.his.web.anesthesia.controller;
 
-import com.baomidou.mybatisplus.core.conditions.query.LambdaQueryWrapper;
-import com.baomidou.mybatisplus.extension.plugins.pagination.Page;
 import com.core.common.core.domain.R;
-import com.healthlink.his.anesthesia.domain.*;
+import com.healthlink.his.anesthesia.domain.AnesthesiaAldreteScore;
-import com.healthlink.his.anesthesia.service.*;
+import com.healthlink.his.anesthesia.domain.AnesthesiaIntraopEvent;
+import com.healthlink.his.anesthesia.domain.AnesthesiaPreopVisit;
+import com.healthlink.his.anesthesia.service.IAnesthesiaAldreteScoreService;
+import com.healthlink.his.anesthesia.service.IAnesthesiaIntraopEventService;
+import com.healthlink.his.anesthesia.service.IAnesthesiaPreopVisitService;
+import io.swagger.v3.oas.annotations.Operation;
+import io.swagger.v3.oas.annotations.tags.Tag;
 import lombok.AllArgsConstructor;
 import lombok.extern.slf4j.Slf4j;
+import org.springframework.security.access.prepost.PreAuthorize;
 import org.springframework.transaction.annotation.Transactional;
-import org.springframework.util.StringUtils;
 import org.springframework.web.bind.annotation.*;
 
-import java.util.*;
+import java.util.Date;
+import java.util.HashMap;
+import java.util.List;
+import java.util.Map;
 
 @RestController
-@RequestMapping("/anesthesia-enhanced")
+@RequestMapping("/api/v1/anesthesia")
+@Tag(name = "麻醉扩展功能")
 @Slf4j
 @AllArgsConstructor
 public class AnesthesiaEnhancedController {
 
-    private final IAnesthesiaSpecimenService specimenService;
+    private final IAnesthesiaPreopVisitService preopVisitService;
-    private final IAnesthesiaPostopFollowupService followupService;
+    private final IAnesthesiaIntraopEventService intraopEventService;
-    private final IAnesthesiaQualityControlService qcService;
+    private final IAnesthesiaAldreteScoreService aldreteScoreService;
 
-    // ==================== 标本管理 ====================
+    @PostMapping("/preop-visit")
-    @GetMapping("/specimen/page")
+    @Operation(summary = "保存麻醉前评估(术前访视)")
-    public R<?> getSpecimenPage(
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:edit')")
-            @RequestParam(value = "patientName", required = false) String patientName,
-            @RequestParam(value = "pathologyStatus", required = false) String status,
-            @RequestParam(value = "pageNo", defaultValue = "1") Integer pageNo,
-            @RequestParam(value = "pageSize", defaultValue = "20") Integer pageSize) {
-        LambdaQueryWrapper<AnesthesiaSpecimen> w = new LambdaQueryWrapper<>();
-        w.like(StringUtils.hasText(patientName), AnesthesiaSpecimen::getPatientName, patientName)
-         .eq(StringUtils.hasText(status), AnesthesiaSpecimen::getPathologyStatus, status)
-         .orderByDesc(AnesthesiaSpecimen::getCreateTime);
-        return R.ok(specimenService.page(new Page<>(pageNo, pageSize), w));
-    }
-
-    @PostMapping("/specimen/add")
     @Transactional(rollbackFor = Exception.class)
-    public R<?> addSpecimen(@RequestBody AnesthesiaSpecimen s) {
+    public R<AnesthesiaPreopVisit> savePreopVisit(@RequestBody AnesthesiaPreopVisit visit) {
-        s.setPathologyStatus("PENDING");
+        if (visit.getId() != null) {
-        s.setCreateTime(new Date());
+            preopVisitService.updateById(visit);
-        specimenService.save(s);
+        } else {
-        return R.ok(s);
+            visit.setCreateTime(new Date());
+            preopVisitService.save(visit);
+        }
+        return R.ok(visit);
     }
 
-    @PostMapping("/specimen/report")
+    @GetMapping("/preop-visit/record/{recordId}")
+    @Operation(summary = "查询麻醉前评估列表")
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:list')")
+    public R<List<AnesthesiaPreopVisit>> getPreopVisits(@PathVariable Long recordId) {
+        return R.ok(preopVisitService.selectByRecordId(recordId));
+    }
+
+    @GetMapping("/preop-visit/encounter/{encounterId}")
+    @Operation(summary = "按就诊查询麻醉前评估")
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:list')")
+    public R<List<AnesthesiaPreopVisit>> getPreopVisitsByEncounter(@PathVariable Long encounterId) {
+        return R.ok(preopVisitService.selectByEncounterId(encounterId));
+    }
+
+    @PostMapping("/intraop-event")
+    @Operation(summary = "记录术中事件(插管/拔管/体位)")
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:edit')")
     @Transactional(rollbackFor = Exception.class)
-    public R<?> reportSpecimen(@RequestBody Map<String, Object> params) {
+    public R<AnesthesiaIntraopEvent> saveIntraopEvent(@RequestBody AnesthesiaIntraopEvent event) {
-        Long id = Long.valueOf(params.get("id").toString());
+        if (event.getId() != null) {
-        AnesthesiaSpecimen s = specimenService.getById(id);
+            intraopEventService.updateById(event);
-        if (s == null) return R.fail("标本不存在");
+        } else {
-        s.setPathologyStatus("REPORTED");
+            event.setCreateTime(new Date());
-        s.setPathologyResult((String) params.get("pathologyResult"));
+            intraopEventService.save(event);
-        s.setReportTime(new Date());
+        }
-        s.setUpdateTime(new Date());
+        return R.ok(event);
-        specimenService.updateById(s);
-        return R.ok();
     }
 
-    // ==================== 术后随访 ====================
+    @GetMapping("/intraop-event/{recordId}")
-    @GetMapping("/followup/page")
+    @Operation(summary = "查询术中事件列表")
-    public R<?> getFollowupPage(
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:list')")
-            @RequestParam(value = "followupType", required = false) String type,
+    public R<List<AnesthesiaIntraopEvent>> getIntraopEvents(@PathVariable Long recordId) {
-            @RequestParam(value = "pageNo", defaultValue = "1") Integer pageNo,
+        return R.ok(intraopEventService.selectByRecordId(recordId));
-            @RequestParam(value = "pageSize", defaultValue = "20") Integer pageSize) {
-        LambdaQueryWrapper<AnesthesiaPostopFollowup> w = new LambdaQueryWrapper<>();
-        w.eq(StringUtils.hasText(type), AnesthesiaPostopFollowup::getFollowupType, type)
-         .orderByDesc(AnesthesiaPostopFollowup::getFollowupTime);
-        return R.ok(followupService.page(new Page<>(pageNo, pageSize), w));
     }
 
-    @PostMapping("/followup/add")
+    @PostMapping("/aldrete-score")
+    @Operation(summary = "保存麻醉复苏评分(PACU Aldrete)")
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:edit')")
     @Transactional(rollbackFor = Exception.class)
-    public R<?> addFollowup(@RequestBody AnesthesiaPostopFollowup f) {
+    public R<AnesthesiaAldreteScore> saveAldreteScore(@RequestBody AnesthesiaAldreteScore score) {
-        f.setStatus(0);
+        int total = (score.getActivityScore() != null ? score.getActivityScore() : 0)
-        f.setCreateTime(new Date());
+                  + (score.getRespirationScore() != null ? score.getRespirationScore() : 0)
-        followupService.save(f);
+                  + (score.getCirculationScore() != null ? score.getCirculationScore() : 0)
-        return R.ok(f);
+                  + (score.getConsciousnessScore() != null ? score.getConsciousnessScore() : 0)
+                  + (score.getSpo2Score() != null ? score.getSpo2Score() : 0);
+        score.setTotalScore(total);
+        if (total >= 9) {
+            score.setRiskLevel("NORMAL");
+        } else if (total >= 7) {
+            score.setRiskLevel("WARNING");
+        } else {
+            score.setRiskLevel("CRITICAL");
+        }
+        if (score.getId() != null) {
+            aldreteScoreService.updateById(score);
+        } else {
+            score.setCreateTime(new Date());
+            aldreteScoreService.save(score);
+        }
+        return R.ok(score);
     }
 
-    // ==================== 麻醉质控 ====================
+    @GetMapping("/aldrete-score/{recordId}")
-    @GetMapping("/qc/page")
+    @Operation(summary = "查询复苏评分列表")
-    public R<?> getQcPage(
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:list')")
-            @RequestParam(value = "pageNo", defaultValue = "1") Integer pageNo,
+    public R<List<AnesthesiaAldreteScore>> getAldreteScores(@PathVariable Long recordId) {
-            @RequestParam(value = "pageSize", defaultValue = "20") Integer pageSize) {
+        return R.ok(aldreteScoreService.selectByRecordId(recordId));
-        LambdaQueryWrapper<AnesthesiaQualityControl> w = new LambdaQueryWrapper<>();
-        w.orderByDesc(AnesthesiaQualityControl::getCreateTime);
-        return R.ok(qcService.page(new Page<>(pageNo, pageSize), w));
     }
 
-    @PostMapping("/qc/add")
+    @GetMapping("/aldrete-score/summary/{recordId}")
-    @Transactional(rollbackFor = Exception.class)
+    @Operation(summary = "复苏评分趋势汇总")
-    public R<?> addQc(@RequestBody AnesthesiaQualityControl qc) {
+    @PreAuthorize("@ss.hasPermi('inpatient:anesthesia:list')")
-        qc.setStatus(0);
+    public R<List<Map<String, Object>>> getAldreteTrend(@PathVariable Long recordId) {
-        qc.setCreateTime(new Date());
+        List<AnesthesiaAldreteScore> scores = aldreteScoreService.selectByRecordId(recordId);
-        qcService.save(qc);
+        return R.ok(scores.stream().map(s -> {
-        return R.ok(qc);
+            Map<String, Object> m = new HashMap<>();
-    }
+            m.put("assessTime", s.getAssessTime());
-
+            m.put("totalScore", s.getTotalScore());
-    @GetMapping("/qc/stats")
+            m.put("riskLevel", s.getRiskLevel());
-    public R<?> getQcStats() {
+            return m;
-        Map<String, Object> stats = new HashMap<>();
+        }).toList());
-        stats.put("total", qcService.count());
-        LambdaQueryWrapper<AnesthesiaQualityControl> w = new LambdaQueryWrapper<>();
-        w.isNotNull(AnesthesiaQualityControl::getComplications);
-        w.ne(AnesthesiaQualityControl::getComplications, "");
-        stats.put("withComplications", qcService.count(w));
-        return R.ok(stats);
     }
 }

healthlink-his-server/healthlink-his-application/src/main/java/com/healthlink/his/web/surgicalschedule/controller/SurgerySafetyCheckController.java

@@ -5,19 +5,26 @@ import com.baomidou.mybatisplus.extension.plugins.pagination.Page;
 import com.core.common.core.domain.R;
 import com.healthlink.his.surgicalschedule.domain.SurgerySafetyCheck;
 import com.healthlink.his.surgicalschedule.service.ISurgerySafetyCheckService;
+import io.swagger.v3.oas.annotations.Operation;
+import io.swagger.v3.oas.annotations.tags.Tag;
 import lombok.AllArgsConstructor;
 import lombok.extern.slf4j.Slf4j;
+import org.springframework.security.access.prepost.PreAuthorize;
 import org.springframework.transaction.annotation.Transactional;
 import org.springframework.util.StringUtils;
 import org.springframework.web.bind.annotation.*;
 
 import java.util.Date;
+import java.util.HashMap;
+import java.util.List;
+import java.util.Map;
 
 /**
  * 术前安全核查 Controller (WS/T 313)
  */
 @RestController
 @RequestMapping("/surgery-safety-check")
+@Tag(name = "手术安全核查")
 @Slf4j
 @AllArgsConstructor
 public class SurgerySafetyCheckController {
@@ -25,6 +32,8 @@ public class SurgerySafetyCheckController {
     private final ISurgerySafetyCheckService safetyCheckService;
 
     @GetMapping("/page")
+    @Operation(summary = "分页查询安全核查")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:list')")
     public R<?> getPage(
             @RequestParam(value = "patientName", required = false) String patientName,
             @RequestParam(value = "encounterId", required = false) Long encounterId,
@@ -40,6 +49,8 @@ public class SurgerySafetyCheckController {
     }
 
     @GetMapping("/list")
+    @Operation(summary = "查询安全核查列表")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:list')")
     public R<?> getList(@RequestParam("encounterId") Long encounterId) {
         LambdaQueryWrapper<SurgerySafetyCheck> w = new LambdaQueryWrapper<>();
         w.eq(SurgerySafetyCheck::getEncounterId, encounterId)
@@ -48,11 +59,15 @@ public class SurgerySafetyCheckController {
     }
 
     @GetMapping("/{id}")
+    @Operation(summary = "获取安全核查详情")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:list')")
     public R<?> getById(@PathVariable Long id) {
         return R.ok(safetyCheckService.getById(id));
     }
 
     @PostMapping("/add")
+    @Operation(summary = "新增安全核查")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:edit')")
     @Transactional(rollbackFor = Exception.class)
     public R<?> add(@RequestBody SurgerySafetyCheck check) {
         check.setCreateTime(new Date());
@@ -61,6 +76,8 @@ public class SurgerySafetyCheckController {
     }
 
     @PutMapping("/update")
+    @Operation(summary = "更新安全核查")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:edit')")
     @Transactional(rollbackFor = Exception.class)
     public R<?> update(@RequestBody SurgerySafetyCheck check) {
         safetyCheckService.updateById(check);
@@ -68,9 +85,45 @@ public class SurgerySafetyCheckController {
     }
 
     @DeleteMapping("/delete/{id}")
+    @Operation(summary = "删除安全核查")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:remove')")
     @Transactional(rollbackFor = Exception.class)
     public R<?> delete(@PathVariable Long id) {
         safetyCheckService.removeById(id);
         return R.ok();
     }
+
+    @GetMapping("/phase-status/{encounterId}")
+    @Operation(summary = "查询各阶段核查完成状态")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:list')")
+    public R<?> getPhaseStatus(@PathVariable Long encounterId) {
+        LambdaQueryWrapper<SurgerySafetyCheck> w = new LambdaQueryWrapper<>();
+        w.eq(SurgerySafetyCheck::getEncounterId, encounterId);
+        List<SurgerySafetyCheck> checks = safetyCheckService.list(w);
+        Map<String, Boolean> phaseMap = new HashMap<>();
+        phaseMap.put("sign_in", false);
+        phaseMap.put("time_out", false);
+        phaseMap.put("sign_out", false);
+        for (SurgerySafetyCheck c : checks) {
+            if (Boolean.TRUE.equals(c.getChecklistCompleted()) && c.getCheckPhase() != null) {
+                phaseMap.put(c.getCheckPhase(), true);
+            }
+        }
+        return R.ok(phaseMap);
+    }
+
+    @GetMapping("/compliance-stats")
+    @Operation(summary = "安全核查合规统计")
+    @PreAuthorize("@ss.hasPermi('surgery:schedule:list')")
+    public R<?> getComplianceStats() {
+        LambdaQueryWrapper<SurgerySafetyCheck> w = new LambdaQueryWrapper<>();
+        long total = safetyCheckService.count(w);
+        w.eq(SurgerySafetyCheck::getChecklistCompleted, true);
+        long completed = safetyCheckService.count(w);
+        Map<String, Object> stats = new HashMap<>();
+        stats.put("total", total);
+        stats.put("completed", completed);
+        stats.put("complianceRate", total > 0 ? (completed * 100.0 / total) : 0);
+        return R.ok(stats);
+    }
 }

healthlink-his-server/healthlink-his-application/src/main/resources/db/migration/V70__anesthesia_enhanced.sql

@@ -0,0 +1,89 @@
+-- V70: 麻醉扩展功能表(术前访视、术中事件、复苏评分)
+
+-- 麻醉前评估(术前访视)
+CREATE TABLE IF NOT EXISTS anes_preop_visit (
+    id              BIGINT PRIMARY KEY,
+    record_id       BIGINT,
+    encounter_id    BIGINT,
+    patient_id      BIGINT,
+    patient_name    VARCHAR(64),
+    visit_doctor_id BIGINT,
+    visit_doctor_name VARCHAR(64),
+    visit_time      TIMESTAMP,
+    chief_complaint TEXT,
+    present_illness TEXT,
+    past_history    TEXT,
+    allergy_history TEXT,
+    airway_assessment VARCHAR(255),
+    asa_grade       VARCHAR(16),
+    cardiovascular_status VARCHAR(255),
+    respiratory_status    VARCHAR(255),
+    neurological_status   VARCHAR(255),
+    hepatorenal_function  VARCHAR(255),
+    coagulation_status    VARCHAR(255),
+    fasting_status  VARCHAR(32),
+    npo_hours       VARCHAR(16),
+    difficult_airway_risk VARCHAR(255),
+    anesthesia_risk VARCHAR(255),
+    risk_factors    TEXT,
+    recommendation  TEXT,
+    status          VARCHAR(16) DEFAULT 'DRAFT',
+    create_by       VARCHAR(64),
+    create_time     TIMESTAMP,
+    update_by       VARCHAR(64),
+    update_time     TIMESTAMP,
+    tenant_id       INT DEFAULT 0,
+    delete_flag     VARCHAR(1) DEFAULT '0'
+);
+
+-- 术中事件记录(插管/拔管/体位)
+CREATE TABLE IF NOT EXISTS anes_intraop_event (
+    id              BIGINT PRIMARY KEY,
+    record_id       BIGINT,
+    encounter_id    BIGINT,
+    patient_id      BIGINT,
+    event_type      VARCHAR(32),
+    event_detail    TEXT,
+    event_time      TIMESTAMP,
+    operator_name   VARCHAR(64),
+    position        VARCHAR(64),
+    intubation_type VARCHAR(64),
+    intubation_result VARCHAR(64),
+    extubation_reason  VARCHAR(255),
+    extubation_result  VARCHAR(64),
+    complication    TEXT,
+    action          TEXT,
+    remark          TEXT,
+    create_by       VARCHAR(64),
+    create_time     TIMESTAMP,
+    update_by       VARCHAR(64),
+    update_time     TIMESTAMP,
+    tenant_id       INT DEFAULT 0,
+    delete_flag     VARCHAR(1) DEFAULT '0'
+);
+
+-- 麻醉复苏评分(PACU Aldrete)
+CREATE TABLE IF NOT EXISTS anes_alldrete_score (
+    id                BIGINT PRIMARY KEY,
+    record_id         BIGINT,
+    encounter_id      BIGINT,
+    patient_id        BIGINT,
+    patient_name      VARCHAR(64),
+    assess_time       TIMESTAMP,
+    activity_score    INT DEFAULT 0,
+    respiration_score INT DEFAULT 0,
+    circulation_score INT DEFAULT 0,
+    consciousness_score INT DEFAULT 0,
+    spo2_score        INT DEFAULT 0,
+    total_score       INT DEFAULT 0,
+    risk_level        VARCHAR(16),
+    assessor_id       BIGINT,
+    assessor_name     VARCHAR(64),
+    remark            TEXT,
+    create_by         VARCHAR(64),
+    create_time       TIMESTAMP,
+    update_by         VARCHAR(64),
+    update_time       TIMESTAMP,
+    tenant_id         INT DEFAULT 0,
+    delete_flag       VARCHAR(1) DEFAULT '0'
+);