feat(rationaldrug): T11.4 肝肾功能自动调量

- 新增 DosageAdjustmentRequestDto 请求DTO
- IRationalDrugAppService 新增 adjustDosageByOrganFunction 方法
- RationalDrugAppServiceImpl 实现肝肾功能评估 + 剂量匹配逻辑
- RationalDrugController 新增 POST /adjust-dosage 端点
- rationaldrug.js 新增前端 API 函数
- 新建 DosageAdjustment.vue 肝肾功能输入 + 调量建议展示

healthlink-his-server/healthlink-his-application/src/main/java/com/healthlink/his/web/rationaldrug/appservice/IRationalDrugAppService.java

@@ -4,6 +4,7 @@ import com.healthlink.his.rationaldrug.domain.DrugInteractionRule;
 import com.healthlink.his.rationaldrug.domain.DrugDosageRange;
 import com.healthlink.his.rationaldrug.dto.AuditResultDto;
 import com.healthlink.his.rationaldrug.dto.AuditStatisticsDto;
+import com.healthlink.his.rationaldrug.dto.DosageAdjustmentRequestDto;
 import com.healthlink.his.rationaldrug.dto.InteractionCheckResultDto;
 import com.healthlink.his.rationaldrug.dto.PrescriptionAuditDto;
 
@@ -74,4 +75,12 @@ public interface IRationalDrugAppService {
      * @return 审核结果
      */
     AuditResultDto checkDosage(String drugCode, BigDecimal dosage, String population);
+
+    /**
+     * 根据肝肾功能自动建议调量
+     *
+     * @param request 调量请求
+     * @return 调量建议结果
+     */
+    AuditResultDto adjustDosageByOrganFunction(DosageAdjustmentRequestDto request);
 }

healthlink-his-server/healthlink-his-application/src/main/java/com/healthlink/his/web/rationaldrug/appservice/impl/RationalDrugAppServiceImpl.java

@@ -6,6 +6,7 @@ import com.healthlink.his.rationaldrug.domain.DrugInteractionRule;
 import com.healthlink.his.rationaldrug.domain.PrescriptionAuditLog;
 import com.healthlink.his.rationaldrug.dto.AuditResultDto;
 import com.healthlink.his.rationaldrug.dto.AuditStatisticsDto;
+import com.healthlink.his.rationaldrug.dto.DosageAdjustmentRequestDto;
 import com.healthlink.his.rationaldrug.dto.InteractionCheckResultDto;
 import com.healthlink.his.rationaldrug.dto.PrescriptionAuditDto;
 import com.healthlink.his.rationaldrug.service.IDrugDosageRangeService;
@@ -257,6 +258,218 @@ public class RationalDrugAppServiceImpl implements IRationalDrugAppService {
         return buildResult("PASS", null, 0, "剂量在合理范围内", null);
     }
 
+    /**
+     * 根据肝肾功能自动建议调量
+     * <p>
+     * 流程：评估肝肾功能损害程度 → 匹配药品剂量规则 → 比较当前剂量 → 生成调量建议
+     * </p>
+     */
+    @Override
+    public AuditResultDto adjustDosageByOrganFunction(DosageAdjustmentRequestDto request) {
+        String drugCode = request.getDrugCode();
+        String organType = request.getOrganFunctionType();
+        String population = request.getPopulation();
+
+        if (drugCode == null || organType == null) {
+            return buildResult("MANUAL", "INVALID_INPUT", 1,
+                    "药品编码和肝肾功能类型不能为空",
+                    "请提供完整的药品编码和肝肾功能类型");
+        }
+
+        // 1. 评估器官功能损害程度
+        String impairmentLevel = assessImpairmentLevel(request);
+        if ("NORMAL".equals(impairmentLevel)) {
+            return buildResult("PASS", null, 0,
+                    "肝肾功能正常，当前剂量无需调整",
+                    "无需调量");
+        }
+
+        // 2. 查询该药品的剂量规则
+        LambdaQueryWrapper<DrugDosageRange> wrapper = new LambdaQueryWrapper<>();
+        wrapper.eq(DrugDosageRange::getDrugCode, drugCode)
+                .eq(DrugDosageRange::getEnabled, "1")
+                .eq(DrugDosageRange::getDelFlag, "0");
+        if (population != null) {
+            wrapper.eq(DrugDosageRange::getPopulation, population);
+        }
+        List<DrugDosageRange> ranges = drugDosageRangeService.list(wrapper);
+
+        if (ranges.isEmpty()) {
+            return buildResult("MANUAL", "DOSAGE_RANGE_NOT_FOUND", 1,
+                    "药品 " + drugCode + " 无剂量范围规则，请先维护剂量规则",
+                    "建议人工确认剂量合理性");
+        }
+
+        // 3. 根据损害程度生成调量建议
+        BigDecimal currentDose = request.getCurrentDose();
+        DrugDosageRange matchedRange = ranges.get(0);
+
+        StringBuilder detail = new StringBuilder();
+        detail.append("肝肾功能评估: ").append(formatOrganType(organType));
+        detail.append(" — ").append(formatImpairmentLevel(impairmentLevel));
+
+        String suggestion;
+        String ruleHit;
+
+        if (currentDose == null) {
+            // 未提供当前剂量，仅给出通用建议
+            suggestion = "基于" + formatImpairmentLevel(impairmentLevel) + "，"
+                    + "建议参考剂量范围 " + matchedRange.getMinDose() + "-"
+                    + matchedRange.getMaxDose() + matchedRange.getDoseUnit();
+            if (matchedRange.getAdjustmentNote() != null) {
+                suggestion += "。" + matchedRange.getAdjustmentNote();
+            }
+            ruleHit = "DOSE_NOT_PROVIDED";
+            detail.append("。未提供当前剂量，给出通用调量建议");
+        } else {
+            BigDecimal minDose = matchedRange.getMinDose();
+            BigDecimal maxDose = matchedRange.getMaxDose();
+
+            if (currentDose.compareTo(minDose) >= 0 && currentDose.compareTo(maxDose) <= 0) {
+                // 当前剂量在正常范围内，但器官功能受损，仍建议减量
+                if ("SEVERE".equals(impairmentLevel)) {
+                    BigDecimal reducedDose = currentDose.multiply(BigDecimal.valueOf(0.5))
+                            .setScale(1, RoundingMode.HALF_UP);
+                    suggestion = "当前剂量 " + currentDose + matchedRange.getDoseUnit()
+                            + " 虽在常规范围内，但" + formatImpairmentLevel(impairmentLevel)
+                            + "，建议减量至 " + reducedDose + matchedRange.getDoseUnit();
+                    if (matchedRange.getAdjustmentNote() != null) {
+                        suggestion += "。" + matchedRange.getAdjustmentNote();
+                    }
+                    ruleHit = "SEVERE_IMPAIRMENT_REDUCE";
+                    detail.append("。当前剂量在常规范围内，但重度损害需减量");
+                } else if ("MODERATE".equals(impairmentLevel)) {
+                    BigDecimal reducedDose = currentDose.multiply(BigDecimal.valueOf(0.75))
+                            .setScale(1, RoundingMode.HALF_UP);
+                    suggestion = "当前剂量 " + currentDose + matchedRange.getDoseUnit()
+                            + " 虽在常规范围内，但" + formatImpairmentLevel(impairmentLevel)
+                            + "，建议减量至 " + reducedDose + matchedRange.getDoseUnit();
+                    if (matchedRange.getAdjustmentNote() != null) {
+                        suggestion += "。" + matchedRange.getAdjustmentNote();
+                    }
+                    ruleHit = "MODERATE_IMPAIRMENT_REDUCE";
+                    detail.append("。当前剂量在常规范围内，中度损害建议适当减量");
+                } else {
+                    suggestion = "当前剂量 " + currentDose + matchedRange.getDoseUnit()
+                            + " 在常规范围内，轻度" + formatOrganType(organType) + "损害，暂无需调整，建议密切监测";
+                    ruleHit = "MILD_IMPAIRMENT_MONITOR";
+                    detail.append("。轻度损害，当前剂量可维持");
+                }
+            } else if (currentDose.compareTo(maxDose) > 0) {
+                // 当前剂量超出范围
+                suggestion = "当前剂量 " + currentDose + matchedRange.getDoseUnit()
+                        + " 超过推荐范围 " + minDose + "-" + maxDose + matchedRange.getDoseUnit()
+                        + "，且存在" + formatImpairmentLevel(impairmentLevel)
+                        + "，强烈建议减量至 " + minDose + "-" + maxDose + matchedRange.getDoseUnit();
+                if (matchedRange.getAdjustmentNote() != null) {
+                    suggestion += "。" + matchedRange.getAdjustmentNote();
+                }
+                ruleHit = "DOSAGE_EXCEEDS_RANGE_WITH_IMPAIRMENT";
+                detail.append("。当前剂量超出推荐范围，叠加器官损害风险更高");
+            } else {
+                // 当前剂量低于范围
+                suggestion = "当前剂量 " + currentDose + matchedRange.getDoseUnit()
+                        + " 低于推荐范围 " + minDose + "-" + maxDose + matchedRange.getDoseUnit()
+                        + "，结合" + formatImpairmentLevel(impairmentLevel)
+                        + "，建议调整至 " + minDose + "-" + maxDose + matchedRange.getDoseUnit();
+                ruleHit = "DOSAGE_BELOW_RANGE_WITH_IMPAIRMENT";
+                detail.append("。当前剂量偏低，结合器官损害情况建议调整");
+            }
+        }
+
+        return buildResult("MANUAL", ruleHit, 1, detail.toString(), suggestion);
+    }
+
+    /**
+     * 评估器官功能损害程度
+     *
+     * @param request 调量请求
+     * @return 损害程度: NORMAL / MILD / MODERATE / SEVERE
+     */
+    private String assessImpairmentLevel(DosageAdjustmentRequestDto request) {
+        String organType = request.getOrganFunctionType();
+        String level = "NORMAL";
+
+        if ("KIDNEY".equals(organType) || "BOTH".equals(organType)) {
+            String kidneyLevel = assessKidneyFunction(request.getEgfr(), request.getCreatinine());
+            level = mergeLevel(level, kidneyLevel);
+        }
+        if ("LIVER".equals(organType) || "BOTH".equals(organType)) {
+            String liverLevel = assessLiverFunction(request.getAlt(), request.getAst());
+            level = mergeLevel(level, liverLevel);
+        }
+        return level;
+    }
+
+    private String assessKidneyFunction(java.math.BigDecimal egfr, java.math.BigDecimal creatinine) {
+        if (egfr != null) {
+            if (egfr.compareTo(java.math.BigDecimal.valueOf(90)) >= 0) return "NORMAL";
+            if (egfr.compareTo(java.math.BigDecimal.valueOf(60)) >= 0) return "MILD";
+            if (egfr.compareTo(java.math.BigDecimal.valueOf(30)) >= 0) return "MODERATE";
+            return "SEVERE";
+        }
+        if (creatinine != null) {
+            if (creatinine.compareTo(java.math.BigDecimal.valueOf(133)) < 0) return "NORMAL";
+            if (creatinine.compareTo(java.math.BigDecimal.valueOf(177)) < 0) return "MILD";
+            if (creatinine.compareTo(java.math.BigDecimal.valueOf(442)) < 0) return "MODERATE";
+            return "SEVERE";
+        }
+        return "NORMAL";
+    }
+
+    private String assessLiverFunction(java.math.BigDecimal alt, java.math.BigDecimal ast) {
+        int level = 0;
+        if (alt != null) {
+            if (alt.compareTo(java.math.BigDecimal.valueOf(40)) >= 0) level = Math.max(level, 1);
+            if (alt.compareTo(java.math.BigDecimal.valueOf(120)) >= 0) level = Math.max(level, 2);
+            if (alt.compareTo(java.math.BigDecimal.valueOf(400)) >= 0) level = Math.max(level, 3);
+        }
+        if (ast != null) {
+            if (ast.compareTo(java.math.BigDecimal.valueOf(40)) >= 0) level = Math.max(level, 1);
+            if (ast.compareTo(java.math.BigDecimal.valueOf(120)) >= 0) level = Math.max(level, 2);
+            if (ast.compareTo(java.math.BigDecimal.valueOf(400)) >= 0) level = Math.max(level, 3);
+        }
+        return switch (level) {
+            case 1 -> "MILD";
+            case 2 -> "MODERATE";
+            case 3 -> "SEVERE";
+            default -> "NORMAL";
+        };
+    }
+
+    private String mergeLevel(String current, String candidate) {
+        int currentLevel = impairmentLevelValue(current);
+        int candidateLevel = impairmentLevelValue(candidate);
+        return candidateLevel > currentLevel ? candidate : current;
+    }
+
+    private int impairmentLevelValue(String level) {
+        return switch (level) {
+            case "SEVERE" -> 3;
+            case "MODERATE" -> 2;
+            case "MILD" -> 1;
+            default -> 0;
+        };
+    }
+
+    private String formatOrganType(String organType) {
+        return switch (organType) {
+            case "LIVER" -> "肝功能";
+            case "KIDNEY" -> "肾功能";
+            case "BOTH" -> "肝肾功能";
+            default -> organType;
+        };
+    }
+
+    private String formatImpairmentLevel(String level) {
+        return switch (level) {
+            case "MILD" -> "轻度损害";
+            case "MODERATE" -> "中度损害";
+            case "SEVERE" -> "重度损害";
+            default -> "正常";
+        };
+    }
+
     /**
      * 保存审核日志
      */

healthlink-his-server/healthlink-his-application/src/main/java/com/healthlink/his/web/rationaldrug/controller/RationalDrugController.java

@@ -5,6 +5,7 @@ import com.healthlink.his.rationaldrug.domain.DrugDosageRange;
 import com.healthlink.his.rationaldrug.domain.DrugInteractionRule;
 import com.healthlink.his.rationaldrug.dto.AuditResultDto;
 import com.healthlink.his.rationaldrug.dto.AuditStatisticsDto;
+import com.healthlink.his.rationaldrug.dto.DosageAdjustmentRequestDto;
 import com.healthlink.his.rationaldrug.dto.InteractionCheckResultDto;
 import com.healthlink.his.rationaldrug.dto.PrescriptionAuditDto;
 import com.healthlink.his.rationaldrug.service.IDrugDosageRangeService;
@@ -14,6 +15,7 @@ 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.web.bind.annotation.*;
 
 import java.math.BigDecimal;
@@ -127,4 +129,12 @@ public class RationalDrugController {
         AuditResultDto result = rationalDrugAppService.checkDosage(drugCode, dosage, population);
         return AjaxResult.success(result);
     }
+
+    @PostMapping("/adjust-dosage")
+    @Operation(summary = "肝肾功能自动调量")
+    @PreAuthorize("hasAuthority('infection:rationaldrug:edit')")
+    public AjaxResult adjustDosageByOrganFunction(@RequestBody DosageAdjustmentRequestDto request) {
+        AuditResultDto result = rationalDrugAppService.adjustDosageByOrganFunction(request);
+        return AjaxResult.success(result);
+    }
 }

healthlink-his-server/healthlink-his-domain/src/main/java/com/healthlink/his/rationaldrug/dto/DosageAdjustmentRequestDto.java

@@ -0,0 +1,43 @@
+package com.healthlink.his.rationaldrug.dto;
+
+import lombok.Data;
+import lombok.experimental.Accessors;
+
+import java.math.BigDecimal;
+
+/**
+ * 肝肾功能调量请求DTO
+ *
+ * @author system
+ */
+@Data
+@Accessors(chain = true)
+public class DosageAdjustmentRequestDto {
+
+    /** 药品编码 */
+    private String drugCode;
+
+    /** 当前剂量 */
+    private BigDecimal currentDose;
+
+    /** 剂量单位 */
+    private String doseUnit;
+
+    /** 肝肾功能类型: LIVER / KIDNEY / BOTH */
+    private String organFunctionType;
+
+    /** 肌酐 (μmol/L) — 肾功能 */
+    private BigDecimal creatinine;
+
+    /** 肾小球滤过率 eGFR (mL/min) — 肾功能 */
+    private BigDecimal egfr;
+
+    /** 谷丙转氨酶 ALT (U/L) — 肝功能 */
+    private BigDecimal alt;
+
+    /** 谷草转氨酶 AST (U/L) — 肝功能 */
+    private BigDecimal ast;
+
+    /** 人群类型: ADULT/CHILD/ELDERLY/PREGNANT */
+    private String population;
+}

healthlink-his-ui/src/api/rationaldrug.js

@@ -50,3 +50,8 @@ export function listDosageRules(params) {
 export function checkDosage(drugCode, dosage, population) {
   return request({ url: '/api/v1/rational-drug/check-dosage', method: 'get', params: { drugCode, dosage, population } })
 }
+
+// ==================== 肝肾功能调量 ====================
+export function adjustDosageByOrganFunction(data) {
+  return request({ url: '/api/v1/rational-drug/adjust-dosage', method: 'post', data })
+}

healthlink-his-ui/src/views/rationaldrug/dosage-adjustment/index.vue

@@ -0,0 +1,295 @@
+<template>
+  <div class="app-container">
+    <el-card shadow="never">
+      <template #header>
+        <div class="card-header">
+          <span>肝肾功能自动调量</span>
+        </div>
+      </template>
+
+      <el-form
+        ref="formRef"
+        :model="form"
+        :rules="rules"
+        label-width="120px"
+      >
+        <el-row :gutter="20">
+          <el-col :span="12">
+            <el-form-item
+              label="药品编码"
+              prop="drugCode"
+            >
+              <el-input
+                v-model="form.drugCode"
+                placeholder="请输入药品编码"
+              />
+            </el-form-item>
+          </el-col>
+          <el-col :span="12">
+            <el-form-item
+              label="人群类型"
+              prop="population"
+            >
+              <el-select
+                v-model="form.population"
+                placeholder="请选择人群类型"
+                style="width: 100%"
+              >
+                <el-option
+                  v-for="item in populationOptions"
+                  :key="item.value"
+                  :label="item.label"
+                  :value="item.value"
+                />
+              </el-select>
+            </el-form-item>
+          </el-col>
+        </el-row>
+
+        <el-row :gutter="20">
+          <el-col :span="8">
+            <el-form-item
+              label="当前剂量"
+              prop="currentDose"
+            >
+              <el-input-number
+                v-model="form.currentDose"
+                :min="0"
+                :precision="1"
+                style="width: 100%"
+              />
+            </el-form-item>
+          </el-col>
+          <el-col :span="8">
+            <el-form-item
+              label="剂量单位"
+              prop="doseUnit"
+            >
+              <el-input
+                v-model="form.doseUnit"
+                placeholder="如 mg、ml"
+              />
+            </el-form-item>
+          </el-col>
+          <el-col :span="8">
+            <el-form-item
+              label="肝肾功能类型"
+              prop="organFunctionType"
+            >
+              <el-select
+                v-model="form.organFunctionType"
+                placeholder="请选择"
+                style="width: 100%"
+              >
+                <el-option
+                  v-for="item in organTypeOptions"
+                  :key="item.value"
+                  :label="item.label"
+                  :value="item.value"
+                />
+              </el-select>
+            </el-form-item>
+          </el-col>
+        </el-row>
+
+        <el-divider content-position="left">
+          肾功能指标
+        </el-divider>
+        <el-row :gutter="20">
+          <el-col :span="8">
+            <el-form-item label="肌酐 (μmol/L)">
+              <el-input-number
+                v-model="form.creatinine"
+                :min="0"
+                :precision="1"
+                style="width: 100%"
+              />
+            </el-form-item>
+          </el-col>
+          <el-col :span="8">
+            <el-form-item label="eGFR (mL/min)">
+              <el-input-number
+                v-model="form.egfr"
+                :min="0"
+                :precision="1"
+                style="width: 100%"
+              />
+            </el-form-item>
+          </el-col>
+        </el-row>
+
+        <el-divider content-position="left">
+          肝功能指标
+        </el-divider>
+        <el-row :gutter="20">
+          <el-col :span="8">
+            <el-form-item label="ALT (U/L)">
+              <el-input-number
+                v-model="form.alt"
+                :min="0"
+                :precision="1"
+                style="width: 100%"
+              />
+            </el-form-item>
+          </el-col>
+          <el-col :span="8">
+            <el-form-item label="AST (U/L)">
+              <el-input-number
+                v-model="form.ast"
+                :min="0"
+                :precision="1"
+                style="width: 100%"
+              />
+            </el-form-item>
+          </el-col>
+        </el-row>
+
+        <el-form-item>
+          <el-button
+            type="primary"
+            :loading="loading"
+            @click="handleSubmit"
+          >
+            生成调量建议
+          </el-button>
+          <el-button @click="handleReset">
+            重置
+          </el-button>
+        </el-form-item>
+      </el-form>
+    </el-card>
+
+    <el-card
+      v-if="result"
+      shadow="never"
+      class="mt20"
+    >
+      <template #header>
+        <div class="card-header">
+          <span>调量建议结果</span>
+          <el-tag :type="resultTagType(result.auditResult)">
+            {{ resultText(result.auditResult) }}
+          </el-tag>
+        </div>
+      </template>
+
+      <el-descriptions
+        :column="1"
+        border
+      >
+        <el-descriptions-item label="审核结果">
+          <el-tag :type="resultTagType(result.auditResult)">
+            {{ resultText(result.auditResult) }}
+          </el-tag>
+        </el-descriptions-item>
+        <el-descriptions-item label="规则命中">
+          {{ result.ruleHit || '无' }}
+        </el-descriptions-item>
+        <el-descriptions-item label="详细评估">
+          {{ result.detail || '无' }}
+        </el-descriptions-item>
+        <el-descriptions-item label="调量建议">
+          <el-alert
+            :title="result.suggestion || '无需调整'"
+            :type="result.auditResult === 'PASS' ? 'success' : 'warning'"
+            show-icon
+            :closable="false"
+          />
+        </el-descriptions-item>
+      </el-descriptions>
+    </el-card>
+  </div>
+</template>
+
+<script setup name="DosageAdjustment" lang="ts">
+import { ref, reactive } from 'vue'
+import { ElMessage } from 'element-plus'
+import { adjustDosageByOrganFunction } from '@/api/rationaldrug'
+
+const formRef = ref(null)
+const loading = ref(false)
+const result = ref(null)
+
+const form = reactive({
+  drugCode: '',
+  population: 'ADULT',
+  currentDose: null,
+  doseUnit: 'mg',
+  organFunctionType: 'KIDNEY',
+  creatinine: null,
+  egfr: null,
+  alt: null,
+  ast: null
+})
+
+const rules = reactive({
+  drugCode: [{ required: true, message: '药品编码不能为空', trigger: 'blur' }],
+  organFunctionType: [{ required: true, message: '请选择肝肾功能类型', trigger: 'change' }]
+})
+
+const populationOptions = [
+  { label: '成人', value: 'ADULT' },
+  { label: '儿童', value: 'CHILD' },
+  { label: '老年', value: 'ELDERLY' },
+  { label: '孕妇', value: 'PREGNANT' }
+]
+
+const organTypeOptions = [
+  { label: '肾功能', value: 'KIDNEY' },
+  { label: '肝功能', value: 'LIVER' },
+  { label: '肝肾功能', value: 'BOTH' }
+]
+
+function resultTagType(auditResult) {
+  const map = { PASS: 'success', REJECT: 'danger', MANUAL: 'warning' }
+  return map[auditResult] || 'info'
+}
+
+function resultText(auditResult) {
+  const map = { PASS: '通过', REJECT: '拒绝', MANUAL: '需人工复核' }
+  return map[auditResult] || '未知'
+}
+
+function handleSubmit() {
+  formRef.value?.validate(valid => {
+    if (!valid) return
+    loading.value = true
+    adjustDosageByOrganFunction(form).then(res => {
+      result.value = res.data
+      ElMessage.success('调量评估完成')
+    }).finally(() => {
+      loading.value = false
+    })
+  })
+}
+
+function handleReset() {
+  formRef.value?.resetFields()
+  Object.assign(form, {
+    drugCode: '',
+    population: 'ADULT',
+    currentDose: null,
+    doseUnit: 'mg',
+    organFunctionType: 'KIDNEY',
+    creatinine: null,
+    egfr: null,
+    alt: null,
+    ast: null
+  })
+  result.value = null
+}
+</script>
+
+<style lang="scss" scoped>
+.app-container {
+  padding: 20px;
+}
+.mt20 {
+  margin-top: 20px;
+}
+.card-header {
+  display: flex;
+  justify-content: space-between;
+  align-items: center;
+}
+</style>