刘金宝
229 lines
12 KiB
Python
229 lines
12 KiB
Python
from __future__ import annotations
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from decimal import Decimal
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from sqlalchemy import BigInteger, Boolean, ForeignKey, Integer, JSON, Numeric, SmallInteger, String, Text, UniqueConstraint
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from sqlalchemy.orm import Mapped, mapped_column, relationship
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from app.db.base import Base
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from app.models.mixins import TimestampMixin
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BIGINT_PK = BigInteger().with_variant(Integer, "sqlite")
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class CaseBase(TimestampMixin, Base):
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"""源库病例主表：保持 case_base 字段稳定，业务兼容字段通过属性派生。"""
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__tablename__ = "case_base"
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id: Mapped[int] = mapped_column(BIGINT_PK, primary_key=True, autoincrement=True, comment="病例ID")
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title: Mapped[str] = mapped_column(String(255), nullable=False, comment="病例标题")
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case_type: Mapped[str] = mapped_column(String(30), nullable=False, index=True, comment="病例类型")
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difficulty: Mapped[str] = mapped_column(String(20), nullable=False, default="medium", index=True, comment="难度")
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difficulty_score: Mapped[int | None] = mapped_column(Integer, comment="难度分")
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chief_complaint: Mapped[str] = mapped_column(Text, nullable=False, comment="主诉")
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description: Mapped[str] = mapped_column(Text, nullable=False, comment="病例描述")
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patient_age: Mapped[int | None] = mapped_column(Integer, comment="患者年龄")
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patient_gender: Mapped[str] = mapped_column(String(10), nullable=False, comment="患者性别")
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tags: Mapped[str] = mapped_column(String(500), nullable=False, default="", comment="标签")
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symptom_tags: Mapped[list] = mapped_column(JSON, nullable=False, default=list, comment="症状标签")
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disease_tags: Mapped[list] = mapped_column(JSON, nullable=False, default=list, comment="疾病标签")
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competency_tags: Mapped[list] = mapped_column(JSON, nullable=False, default=list, comment="能力标签")
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guideline_tags: Mapped[list] = mapped_column(JSON, nullable=False, default=list, comment="指南标签")
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knowledge_points: Mapped[list] = mapped_column(JSON, nullable=False, default=list, comment="知识点")
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icd_codes: Mapped[str] = mapped_column(String(500), nullable=False, default="", comment="ICD编码")
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estimated_minutes: Mapped[int | None] = mapped_column(Integer, comment="预计训练分钟数")
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osce_enabled: Mapped[bool] = mapped_column(Boolean, nullable=False, default=False, comment="是否启用OSCE")
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rag_enabled: Mapped[bool] = mapped_column(Boolean, nullable=False, default=False, comment="是否启用RAG")
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ai_prompt_template: Mapped[str] = mapped_column(Text, nullable=False, default="", comment="病例AI提示词片段")
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multimodal_assets: Mapped[list] = mapped_column(JSON, nullable=False, default=list, comment="多模态资源")
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vector_status: Mapped[int] = mapped_column(SmallInteger, nullable=False, default=0, comment="向量状态")
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publish_status: Mapped[int] = mapped_column(SmallInteger, nullable=False, default=1, index=True, comment="发布状态")
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status: Mapped[int] = mapped_column(SmallInteger, nullable=False, default=1, index=True, comment="启用状态")
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created_by_id: Mapped[int | None] = mapped_column(BigInteger, nullable=True, index=True, comment="创建人ID")
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department_id: Mapped[int | None] = mapped_column(BigInteger, nullable=True, index=True, comment="科室ID")
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traditional_case = relationship("TraditionalCase", back_populates="case", uselist=False, cascade="all, delete-orphan")
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teaching_case = relationship("TeachingCase", back_populates="case", uselist=False, cascade="all, delete-orphan")
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scoring_rules = relationship("ScoringRule", back_populates="case", cascade="all, delete-orphan")
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exam_items = relationship("CaseExamItem", back_populates="case", cascade="all, delete-orphan")
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__table_args__ = {"comment": "病例主表"}
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@property
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def case_code(self) -> str:
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"""病例编码：源表没有独立编码时用稳定派生值兼容前端。"""
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return f"CASE_{self.id}"
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@property
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def patient_name(self) -> None:
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"""患者姓名：源表不保存患者姓名。"""
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return None
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@property
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def patient_occupation(self) -> None:
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"""患者职业：源表不保存职业。"""
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return None
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@property
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def supported_training_type(self) -> str:
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"""训练类别：沿用源库 case_type，异常值按诊疗练习处理。"""
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return self.case_type if self.case_type in {"case_analysis", "diagnosis_treatment", "consultation"} else "diagnosis_treatment"
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@property
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def supported_mode(self) -> str:
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"""交互模式：存在 teaching_case 时为互动模式，否则为自由问诊。"""
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return "interactive" if self.teaching_case else "free_chat"
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@property
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def has_teaching_video(self) -> bool:
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"""教学视频标记：从多模态资源判断是否存在视频。"""
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return any(isinstance(item, dict) and item.get("type") == "video" for item in (self.multimodal_assets or []))
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@property
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def has_knowledge_points(self) -> bool:
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"""知识点标记：由源表 knowledge_points 判断。"""
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return bool(self.knowledge_points)
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@property
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def has_quiz(self) -> bool:
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"""题库标记：教学互动扩展表存在讨论题时视为有题库入口。"""
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return bool(self.teaching_case and self.teaching_case.discussion_questions)
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@property
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def patient_opening(self) -> str:
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"""AI 病人开场：根据主诉派生，不新增源表字段。"""
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return f"家长：医生，孩子{self.chief_complaint}，想请您看看。"
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@property
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def ai_patient_profile(self) -> dict:
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"""AI 病人人设：由病例描述和提示词动态形成基础人设。"""
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return {
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"speaker": "患儿家长",
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"answer_style": "简短、真实、只回答被问到的信息",
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"prompt_template": self.ai_prompt_template,
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}
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@property
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def hidden_patient_info(self) -> dict:
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"""隐藏病情信息：使用病例描述和传统病例指南作为上下文。"""
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return {
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"case_description": self.description,
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"guideline_reference": self.traditional_case.guideline_reference if self.traditional_case else "",
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"teaching_goal": self.teaching_case.teaching_goal if self.teaching_case else "",
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}
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@property
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def key_symptoms(self) -> list:
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"""关键症状：使用源库 symptom_tags。"""
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return self.symptom_tags or []
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@property
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def key_exams(self) -> list:
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"""关键检查：使用源库 knowledge_points 作为演示阶段考核提示。"""
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return self.knowledge_points or []
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@property
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def key_points(self) -> list:
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"""考核要点：使用源库 competency_tags。"""
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return self.competency_tags or []
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@property
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def diagnosis_primary(self) -> str:
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"""标准诊断：练习模式来自 traditional_case.standard_diagnosis。"""
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return self.traditional_case.standard_diagnosis if self.traditional_case else ""
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@property
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def diagnosis_basis(self) -> str:
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"""诊断依据：优先使用 traditional_case.guideline_reference。"""
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if self.traditional_case:
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return self.traditional_case.guideline_reference
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return self.description
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@property
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def treatment_plan(self) -> dict:
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"""标准治疗：练习模式来自 traditional_case.standard_treatment。"""
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return {"standard_treatment": self.traditional_case.standard_treatment} if self.traditional_case else {}
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class TraditionalCase(TimestampMixin, Base):
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"""源库传统病例表：练习模式读取 case_base + traditional_case。"""
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__tablename__ = "traditional_case"
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id: Mapped[int] = mapped_column(BIGINT_PK, primary_key=True, autoincrement=True, comment="传统病例ID")
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standard_diagnosis: Mapped[str] = mapped_column(Text, nullable=False, comment="标准诊断")
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standard_treatment: Mapped[str] = mapped_column(Text, nullable=False, comment="标准治疗")
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guideline_reference: Mapped[str] = mapped_column(Text, nullable=False, comment="指南参考")
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case_id: Mapped[int] = mapped_column(ForeignKey("case_base.id"), nullable=False, unique=True, index=True, comment="病例ID")
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case = relationship("CaseBase", back_populates="traditional_case")
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__table_args__ = {"comment": "传统病例扩展表"}
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class TeachingCase(TimestampMixin, Base):
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"""源库教学互动病例表：教学互动模式读取 case_base + teaching_case。"""
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__tablename__ = "teaching_case"
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id: Mapped[int] = mapped_column(BIGINT_PK, primary_key=True, autoincrement=True, comment="教学互动病例ID")
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teaching_goal: Mapped[str] = mapped_column(Text, nullable=False, comment="教学目标")
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discussion_questions: Mapped[str] = mapped_column(Text, nullable=False, comment="讨论问题")
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teacher_guide: Mapped[str] = mapped_column(Text, nullable=False, comment="教师引导")
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scoring_focus: Mapped[str] = mapped_column(Text, nullable=False, comment="评分重点")
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case_id: Mapped[int] = mapped_column(ForeignKey("case_base.id"), nullable=False, unique=True, index=True, comment="病例ID")
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case = relationship("CaseBase", back_populates="teaching_case")
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__table_args__ = {"comment": "教学互动病例扩展表"}
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class ScoringRule(TimestampMixin, Base):
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"""源库评分规则表：评价时作为基础评分细则输入 Scoring Agent。"""
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__tablename__ = "scoring_rule"
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id: Mapped[int] = mapped_column(BIGINT_PK, primary_key=True, autoincrement=True, comment="评分规则ID")
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dimension: Mapped[str] = mapped_column(String(50), nullable=False, index=True, comment="一级维度")
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competency_dimension: Mapped[str] = mapped_column(String(50), nullable=False, index=True, comment="能力维度")
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score_weight: Mapped[Decimal] = mapped_column(Numeric(5, 2), nullable=False, comment="分值权重")
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ai_auto_score: Mapped[bool] = mapped_column(Boolean, nullable=False, default=True, comment="是否AI自动评分")
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osce_dimension: Mapped[bool] = mapped_column(Boolean, nullable=False, default=False, comment="是否OSCE维度")
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scoring_standard: Mapped[str] = mapped_column(Text, nullable=False, comment="评分标准")
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rubric_json: Mapped[dict] = mapped_column(JSON, nullable=False, default=dict, comment="结构化评分细则")
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case_id: Mapped[int] = mapped_column(ForeignKey("case_base.id"), nullable=False, index=True, comment="病例ID")
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case = relationship("CaseBase", back_populates="scoring_rules")
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__table_args__ = (
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UniqueConstraint("case_id", "dimension", "competency_dimension", name="uk_scoring_rule_case_dimension"),
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{"comment": "评分规则表"},
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)
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class CaseExamItem(TimestampMixin, Base):
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"""病例检查检验项目表：保存固定检查结果，避免由 LLM 编造检查/检验数据。"""
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__tablename__ = "case_exam_item"
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id: Mapped[int] = mapped_column(BIGINT_PK, primary_key=True, autoincrement=True, comment="检查项目ID")
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case_id: Mapped[int] = mapped_column(ForeignKey("case_base.id"), nullable=False, index=True, comment="病例ID")
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item_code: Mapped[str] = mapped_column(String(64), nullable=False, index=True, comment="检查项目编码")
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item_name: Mapped[str] = mapped_column(String(128), nullable=False, comment="检查项目名称")
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item_type: Mapped[str] = mapped_column(String(32), nullable=False, index=True, comment="项目类型")
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category: Mapped[str | None] = mapped_column(String(64), comment="项目分类")
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result_text: Mapped[str] = mapped_column(Text, nullable=False, comment="固定返回结果文本")
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result_structured: Mapped[dict | None] = mapped_column(JSON, comment="结构化检查结果")
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is_key: Mapped[bool] = mapped_column(Boolean, default=False, comment="是否关键检查")
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is_abnormal: Mapped[bool] = mapped_column(Boolean, default=False, comment="是否异常结果")
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score_weight: Mapped[Decimal] = mapped_column(Numeric(5, 2), default=0, comment="评分权重")
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display_order: Mapped[int] = mapped_column(Integer, default=0, comment="展示顺序")
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case = relationship("CaseBase", back_populates="exam_items")
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__table_args__ = (
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UniqueConstraint("case_id", "item_code", name="uk_case_exam_item_code"),
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{"comment": "病例检查检验项目表"},
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)
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