fastapi/scripts/init_demo_db.py

from __future__ import annotations

import sys
import json
from pathlib import Path

from sqlalchemy import select

sys.path.insert(0, str(Path(__file__).resolve().parents[1]))

from app.db.base import Base
from app.db.session import SessionLocal, engine
from app.models import (
    CaseBase,
    CaseExamItem,
    Department,
    KnowledgeChunk,
    KnowledgeDocument,
    KnowledgeSource,
    PromptTemplate,
    ScoringRule,
    TeachingCase,
    TraditionalCase,
)


def init_database() -> None:
    """数据库初始化：创建当前新表体系并写入第一版 Demo 种子数据。"""
    Base.metadata.create_all(bind=engine)
    with SessionLocal() as db:
        seed_demo_data(db)
        db.commit()


def seed_demo_data(db) -> None:
    """Demo 数据初始化：仅为本地/测试库写入儿科病例和基础训练数据。"""
    department = _get_or_create_department(db)
    case = _get_or_create_case_base(db, department.id)
    _seed_traditional_case(db, case.id)
    _seed_teaching_case(db, case.id)
    _seed_exam_items(db, case.id)
    _seed_scoring_rules(db, case.id)
    _seed_knowledge(db, department.id)
    _seed_prompts(db)


def _get_or_create_department(db) -> Department:
    """科室种子：写入儿科科室。"""
    department = db.scalar(select(Department).where(Department.name == "儿科"))
    if department:
        return department
    department = Department(name="儿科", category="clinical", institution_id=1)
    db.add(department)
    db.flush()
    return department


def _get_or_create_case_base(db, department_id: int) -> CaseBase:
    """病例主表种子：以 case_base 作为病例唯一主表。"""
    case = db.scalar(select(CaseBase).where(CaseBase.title == "支气管肺炎 - 6岁男性患儿"))
    if case:
        return case
    case = CaseBase(
        title="支气管肺炎 - 6岁男性患儿",
        case_type="diagnosis_treatment",
        difficulty="medium",
        difficulty_score=2,
        chief_complaint="发热、咳嗽4天，喘息1天",
        description=(
            "患儿4天前无明显诱因出现发热，最高体温39.2℃，伴阵发性咳嗽，后有少量白色黏痰。"
            "1天前出现喘息，夜间明显，活动后加重。精神较差，食欲下降，小便略少。"
        ),
        patient_age=6,
        patient_gender="male",
        tags="pediatrics,pneumonia,demo",
        symptom_tags=["发热", "咳嗽", "喘息", "精神食纳差"],
        disease_tags=["支气管肺炎"],
        competency_tags=["问诊完整性", "儿科查体规范", "关键症状识别", "诊断准确性", "治疗计划合理性"],
        guideline_tags=["CAP_2019", "HUMANISTIC_CARE"],
        knowledge_points=["血常规", "CRP", "胸片", "血氧饱和度", "肺部湿啰音"],
        icd_codes="",
        estimated_minutes=20,
        osce_enabled=False,
        rag_enabled=True,
        ai_prompt_template="app/prompts/patient/practice.md",
        multimodal_assets=[],
        vector_status=0,
        publish_status=1,
        status=1,
        created_by_id=None,
        department_id=department_id,
    )
    db.add(case)
    db.flush()
    return case


def _seed_traditional_case(db, case_id: int) -> None:
    """传统病例种子：练习模式读取 case_base + traditional_case。"""
    if db.scalar(select(TraditionalCase).where(TraditionalCase.case_id == case_id)):
        return
    db.add(
        TraditionalCase(
            case_id=case_id,
            standard_diagnosis="支气管肺炎",
            standard_treatment=(
                "抗感染、止咳平喘、改善氧合、严密观察病情变化；必要时雾化吸入缓解喘息，"
                "监测体温、呼吸、血氧、精神反应和饮水尿量，出现低氧或呼吸困难加重时及时升级处理。"
            ),
            guideline_reference=(
                "诊断依据：发热、咳嗽、喘息，肺部湿啰音，炎症指标升高，胸片提示右下肺片状模糊影，"
                "符合儿童社区获得性肺炎/支气管肺炎诊断思路。严重程度需结合呼吸频率、SpO2、意识、循环和进食饮水情况。"
            ),
        )
    )


def _seed_teaching_case(db, case_id: int) -> None:
    """教学互动病例种子：教学互动模式读取 case_base + teaching_case。"""
    existing = db.scalar(select(TeachingCase).where(TeachingCase.case_id == case_id))
    if existing:
        try:
            json.loads(existing.discussion_questions)
        except (TypeError, json.JSONDecodeError):
            existing.discussion_questions = _demo_teaching_questions_json()
        return
    questions_json = _demo_teaching_questions_json()
    case = db.get(CaseBase, case_id)
    if case and not case.multimodal_assets:
        case.multimodal_assets = [{"type": "video", "title": "儿童肺炎教学示例视频", "url": ""}]
    db.add(
        TeachingCase(
            case_id=case_id,
            teaching_goal="围绕儿科肺炎问诊、检查选择、诊断依据、治疗决策和医患沟通完成互动训练。",
            discussion_questions=questions_json,
            teacher_guide="观察学生是否完整追问发热、咳嗽、喘息、既往史、接触史，并能解释胸片、炎症指标和血氧。",
            scoring_focus="问诊完整性、检查合理性、诊断准确性、治疗计划、风险预案、人文沟通。",
        )
    )


def _demo_teaching_questions_json() -> str:
    """教学题库种子：为儿科支气管肺炎病例生成可测试的选择题、答案、解析和视频字段。"""
    video = {"title": "儿童肺炎教学示例视频", "url": ""}
    questions = [
        {
            "question_id": "q1",
            "question_type": "single_choice",
            "stem": "该患儿最需要优先关注的病情严重程度指标是？",
            "options": [
                {"key": "A", "text": "体温峰值"},
                {"key": "B", "text": "血氧饱和度"},
                {"key": "C", "text": "咳嗽天数"},
                {"key": "D", "text": "食欲下降"},
            ],
            "answer": "B",
            "analysis": "血氧饱和度能帮助判断低氧和肺炎严重程度，是处置决策的重要依据。",
            "video": video,
            "knowledge_points": ["严重程度评估", "血氧判断"],
        },
        {
            "question_id": "q2",
            "question_type": "single_choice",
            "stem": "结合发热、咳嗽、喘息和肺部湿啰音，最符合的诊断方向是？",
            "options": [
                {"key": "A", "text": "支气管肺炎"},
                {"key": "B", "text": "急性胃肠炎"},
                {"key": "C", "text": "泌尿系感染"},
                {"key": "D", "text": "单纯过敏性鼻炎"},
            ],
            "answer": "A",
            "analysis": "呼吸道症状、肺部体征和影像/炎症指标共同支持儿童支气管肺炎。",
            "video": video,
            "knowledge_points": ["诊断依据", "肺部体征"],
        },
        {
            "question_id": "q3",
            "question_type": "single_choice",
            "stem": "下列哪组检查最有助于完善本例肺炎诊断和严重程度评估？",
            "options": [
                {"key": "A", "text": "血常规、CRP、胸片、血氧饱和度"},
                {"key": "B", "text": "肝功能、甲状腺功能、腹部超声"},
                {"key": "C", "text": "胃镜、幽门螺杆菌、粪便常规"},
                {"key": "D", "text": "骨龄片、维生素D、微量元素"},
            ],
            "answer": "A",
            "analysis": "炎症指标、胸部影像和血氧情况可共同支撑诊断和严重程度判断。",
            "video": video,
            "knowledge_points": ["检查选择", "辅助检查"],
        },
        {
            "question_id": "q4",
            "question_type": "single_choice",
            "stem": "治疗方案中最需要覆盖的核心原则是？",
            "options": [
                {"key": "A", "text": "抗感染、止咳平喘、改善氧合、严密观察"},
                {"key": "B", "text": "立即长期激素维持治疗"},
                {"key": "C", "text": "只需补充维生素"},
                {"key": "D", "text": "无需随访观察"},
            ],
            "answer": "A",
            "analysis": "儿童肺炎处置需围绕抗感染、呼吸症状缓解、氧合监测和病情变化预案展开。",
            "video": video,
            "knowledge_points": ["治疗原则", "风险预案"],
        },
        {
            "question_id": "q5",
            "question_type": "single_choice",
            "stem": "向家属沟通时，最合适的内容是？",
            "options": [
                {"key": "A", "text": "说明病情、观察指标、用药注意事项和复诊/住院指征"},
                {"key": "B", "text": "只告知已经开药即可"},
                {"key": "C", "text": "不需要解释检查结果"},
                {"key": "D", "text": "避免回答家属担心的问题"},
            ],
            "answer": "A",
            "analysis": "儿科场景需要重视家属知情、风险信号识别和家庭护理教育。",
            "video": video,
            "knowledge_points": ["人文沟通", "健康教育"],
        },
    ]
    return json.dumps(questions, ensure_ascii=False)


def _seed_exam_items(db, case_id: int) -> None:
    """检查项目种子：写入病例可申请检查和固定返回结果。"""
    if db.scalar(select(CaseExamItem).where(CaseExamItem.case_id == case_id)):
        return
    items = [
        ("lung_auscultation", "肺部听诊", "physical_exam", "双肺呼吸音粗，可闻及散在湿啰音，右下肺较明显。", {"finding": "散在湿啰音", "location": "右下肺明显"}, True, True, 0),
        ("blood_routine", "血常规", "lab", "WBC 12.5×10^9/L，中性粒细胞比例72%，提示感染及炎症反应。", {"wbc": "12.5×10^9/L", "neutrophil": "72%"}, True, True, 1),
        ("crp", "CRP", "lab", "CRP 28 mg/L，提示炎症反应升高。", {"crp": "28 mg/L"}, True, True, 2),
        ("chest_xray", "胸片", "imaging", "双下肺纹理增多，右下肺片状模糊影，支持肺部感染。", {"finding": "右下肺片状模糊影"}, True, True, 3),
        ("spo2", "血氧饱和度", "vital_sign", "室内空气 SpO2 94%，处于临界偏低范围。", {"spo2": "94%"}, True, True, 4),
        ("mp_igm", "肺炎支原体IgM", "lab", "肺炎支原体IgM阴性。", {"mp_igm": "negative"}, False, False, 5),
    ]
    for code, name, item_type, result_text, structured, is_key, abnormal, order in items:
        db.add(
            CaseExamItem(
                case_id=case_id,
                item_code=code,
                item_name=name,
                item_type=item_type,
                category=item_type,
                result_text=result_text,
                result_structured=structured,
                is_key=is_key,
                is_abnormal=abnormal,
                score_weight=5.0 if is_key else 1.0,
                display_order=order,
            )
        )


def _seed_scoring_rules(db, case_id: int) -> None:
    """评分规则种子：写入 scoring_rule，评价时作为基础评分细则。"""
    if db.scalar(select(ScoringRule).where(ScoringRule.case_id == case_id)):
        return
    rules = [
        ("信息获取", "问诊完整性", 25, "覆盖现病史、既往史、个人史、家族史、儿科特异性症状与家属担忧。"),
        ("分析推理", "诊断与鉴别诊断", 25, "结合症状、体征、胸片、炎症指标和血氧支持支气管肺炎诊断，并列出合理鉴别诊断。"),
        ("处置决策", "检查与治疗方案", 20, "检查申请合理，治疗原则覆盖抗感染、止咳平喘、改善氧合、风险预案和随访。"),
        ("沟通人文", "家属沟通", 15, "向家属说明病情、用药注意事项、危险信号、复诊或住院指征，并回应焦虑。"),
        ("临床整合", "流程与整体思维", 15, "流程连贯，把问诊、检查、诊断、治疗和沟通整合成完整临床决策。"),
    ]
    for dimension, competency, weight, standard in rules:
        db.add(
            ScoringRule(
                case_id=case_id,
                dimension=dimension,
                competency_dimension=competency,
                score_weight=weight,
                ai_auto_score=True,
                osce_dimension=False,
                scoring_standard=standard,
                rubric_json={"max_score": weight, "criteria": standard},
            )
        )


def _seed_knowledge(db, department_id: int) -> None:
    """知识库种子：写入评分参考指南和人文沟通片段。"""
    if db.scalar(select(KnowledgeSource).where(KnowledgeSource.source_code == "CAP_2019")):
        return
    source = KnowledgeSource(
        source_code="CAP_2019",
        source_name="儿童社区获得性肺炎诊疗规范（2019年版）",
        source_type="clinical_guideline",
        authority_level=5,
        is_active=True,
    )
    human = KnowledgeSource(
        source_code="HUMANISTIC_CARE",
        source_name="问诊沟通与人文关怀要求",
        source_type="humanistic_care",
        authority_level=4,
        is_active=True,
    )
    db.add_all([source, human])
    db.flush()
    doc = KnowledgeDocument(
        source_id=source.id,
        department_id=department_id,
        title="儿童社区获得性肺炎诊疗规范摘要",
        task_type="diagnosis_treatment",
        summary="用于肺炎病例诊断、严重程度评估和治疗评分参考。",
        file_path="docs/knowledge/cap_2019.md",
        is_active=True,
    )
    human_doc = KnowledgeDocument(
        source_id=human.id,
        department_id=department_id,
        title="儿科问诊人文关怀要点",
        task_type="diagnosis_treatment",
        summary="用于评价家属沟通、知情告知和健康教育。",
        file_path="docs/knowledge/humanistic_care.md",
        is_active=True,
    )
    db.add_all([doc, human_doc])
    db.flush()
    db.add_all(
        [
            KnowledgeChunk(
                document_id=doc.id,
                department_id=department_id,
                task_type="diagnosis_treatment",
                chunk_text="儿童肺炎诊断需综合发热、咳嗽、喘息、肺部湿啰音、炎症指标和胸部影像学新发浸润影。",
                keywords=["发热", "咳嗽", "喘息", "胸片异常"],
                weight=5.0,
                is_active=True,
            ),
            KnowledgeChunk(
                document_id=doc.id,
                department_id=department_id,
                task_type="diagnosis_treatment",
                chunk_text="严重程度评估应关注呼吸频率、血氧饱和度、意识状态、循环状态和进食饮水情况。",
                keywords=["血氧饱和度下降", "呼吸", "严重程度"],
                weight=4.5,
                is_active=True,
            ),
            KnowledgeChunk(
                document_id=human_doc.id,
                department_id=department_id,
                task_type="diagnosis_treatment",
                chunk_text="儿科问诊需要向家属说明病情观察指标、用药注意事项、复诊指征，并给予情绪安抚。",
                keywords=["沟通", "健康教育", "家属"],
                weight=4.0,
                is_active=True,
            ),
        ]
    )


def _seed_prompts(db) -> None:
    """提示词种子：写入 Markdown 模板元数据，正文保存在 prompts 目录。"""
    templates = [
        ("patient_practice", "patient", "practice", "v1", "fast", "text", "app/prompts/patient/practice.md"),
        ("patient_teaching", "patient", "teaching", "v1", "fast", "text", "app/prompts/patient/teaching.md"),
        ("novice_case_hint", "hint", "novice", "v1", "fast", "json", "app/prompts/hint/novice_case_hint.md"),
        ("scoring_pediatrics_pneumonia", "scoring", "pediatrics_pneumonia", "v1", "fast", "json", "app/prompts/scoring/pediatrics_pneumonia.md"),
        ("scoring_teaching_interaction", "scoring", "teaching_interaction", "v1", "fast", "json", "app/prompts/scoring/teaching_interaction_evaluation.md"),
        ("report_evaluation", "report", "evaluation", "v1", "fast", "json", "app/prompts/report/evaluation_report.md"),
    ]
    for code, agent_type, scene, version, model_type, output_format, file_path in templates:
        template = db.scalar(select(PromptTemplate).where(PromptTemplate.template_code == code, PromptTemplate.version_no == version))
        if not template:
            template = PromptTemplate(template_code=code, version_no=version)
        template.agent_type = agent_type
        template.scene = scene
        template.model_type = model_type
        template.output_format = output_format
        template.file_path = file_path
        template.is_active = True
        db.add(template)


def ensure_storage_dirs() -> None:
    """目录初始化：创建报告导出目录。"""
    Path("storage/reports").mkdir(parents=True, exist_ok=True)


if __name__ == "__main__":
    ensure_storage_dirs()
    init_database()
    print("Demo database initialized.")