王天骄
2 lines
19 KiB
JavaScript
2 lines
19 KiB
JavaScript
import{D as e,d as a,a as l,b as t,c as s,B as n,o,e as i,f as c,C as r,w as u,i as d,j as m,t as f,l as p,m as g,F as h,n as _,k as v,g as b,q as y,y as k,z as w,x,S as $,u as C,I as V,K as D}from"./index-CO9MSRh5.js";import{c as O,_ as F}from"./navigation.CR32hNeX.js";import S from"./pages-diagnosis-diagnosis.66q0uZui.js";import{_ as E}from"./_plugin-vue_export-helper.BCo6x5W8.js";function I(){const a=e("clinical-thinking-access-token");if("string"!=typeof a||!a.trim())throw new Error("登录已过期，请重新登录");return a}function T(e="application/json"){return{"Content-Type":"application/json",Accept:e,Authorization:`Bearer ${I()}`,"X-Entry-Scene":"vue_frontend"}}async function P(e){const a=await e.text().catch((()=>""));if(!a)return`请求失败（${e.status}）`;try{const e=JSON.parse(a),l=e.message||e.detail||e.error;if("string"==typeof l&&l.trim())return l}catch{}return a}async function j(e){var a;const l=await fetch("/fastapi/api/v1/sessions",{method:"POST",headers:T(),body:JSON.stringify(e)});if(!l.ok)throw new Error(await P(l));const t=await l.json();if("OK"!==t.code||!(null==(a=t.data)?void 0:a.session_id))throw new Error(t.message||"新建会话失败");return t.data}const A={id:"case-1006004",title:"持续胸痛3小时",patientName:"陈先生",gender:"男",age:60,department:"心血管内科",scene:"住院部",caseNo:"1006004",tone:"orange",mode:"training"};const N=E(a({__name:"chat",props:{caseItem:{}},emits:["open-settings","open-profile","go-home"],setup(a,{emit:E}){const I=a,j=E,N=O(j),U=l({patient:{name:"陈先生",gender:"男",age:60,department:"心血管内科",chiefComplaint:"持续胸痛3小时"},stages:[{key:"history",label:"病史采集",active:!0},{key:"diagnosis",label:"初步诊断",active:!1},{key:"treatment",label:"治疗方案",active:!1}],messages:[]}),J=t(""),q=t(!1),z=t(!1),B=t(0),H=t(""),M=t(!1),R=t(!1),X=t(!1),K=t(!1),G=t(null);let Q=null,L=null,W=null;const Y=[{name:"心电图",result:"检查结果：床边12导联心电图提示窦性心律，II、III、aVF 导联 ST 段抬高，提示下壁急性心肌梗死可能。"},{name:"胸部X线",result:"检查结果：胸部X线未见明显气胸或纵隔明显增宽，心影大小基本正常，不能排除急性冠脉综合征。"},{name:"心脏超声",result:"检查结果：心脏超声提示左室下壁节段性运动减低，未见大量心包积液，需结合心电图及心肌标志物判断。"},{name:"冠脉CTA",result:"检查结果：冠脉CTA提示右冠状动脉近段重度狭窄/闭塞可能，建议结合急诊介入评估。"}],Z=l({temperature:"",pulse:"",respiration:"",bloodPressure:"",spo2:"",complexion:"",examFinding:"",otherFinding:""}),ee=s((()=>U.patient.chiefComplaint.includes("胸痛")?"胸痛":U.patient.chiefComplaint.slice(0,6)));function ae(){K.value=!1,X.value=!0}function le(){X.value=!1,K.value=!0}function te(){const e=[Z.temperature.trim()?`体温 ${Z.temperature.trim()}℃`:"",Z.pulse.trim()?`心率 ${Z.pulse.trim()}次/分`:"",Z.respiration.trim()?`呼吸 ${Z.respiration.trim()}次/分`:"",Z.bloodPressure.trim()?`血压 ${Z.bloodPressure.trim()}mmHg`:"",Z.spo2.trim()?`血氧 ${Z.spo2.trim()}%`:"",Z.complexion.trim()?`意识/面色：${Z.complexion.trim()}`:"",Z.examFinding.trim()?`心肺/腹部查体：${Z.examFinding.trim()}`:"",Z.otherFinding.trim()?`其他发现：${Z.otherFinding.trim()}`:""].filter(Boolean);if(0===e.length)return void re("请至少录入一项体格检查");const a=Date.now(),l=[{id:`doctor-physical-${a}`,role:"doctor",content:`录入体格检查：${e.join("；")}`,label:"我"},{id:`mentor-physical-${a+1}`,role:"mentor",content:se(),label:"AI助手"}];U.messages.push(...l),K.value=!1,Z.temperature="",Z.pulse="",Z.respiration="",Z.bloodPressure="",Z.spo2="",Z.complexion="",Z.examFinding="",Z.otherFinding="",ce()}function se(){const e=Number(Z.pulse),a=Number(Z.respiration),l=Number(Z.spo2),t=Number(Z.temperature),s=[];e>=100&&s.push("心率偏快"),a>=22&&s.push("呼吸频率偏快"),l>0&&l<95&&s.push("血氧偏低"),t>=37.3&&s.push("体温偏高"),(Z.complexion.includes("苍白")||Z.complexion.includes("出汗"))&&s.push("面色/出汗提示急性病容"),(Z.otherFinding.includes("血压差")||Z.otherFinding.includes("双侧"))&&s.push("双侧血压或脉搏差异需警惕主动脉夹层");return`${s.length?`已记录体格检查。当前提示：${s.join("、")}。`:"已记录体格检查，暂未见明确异常体征。"}建议结合胸痛性质、心电图及心肌标志物进一步判断，并持续监测生命体征变化。`}function ne(){const e=J.value.trim();if(e&&!q.value){if(J.value="",G.value)return U.messages.push({id:`doctor-${Date.now()}`,role:"doctor",content:e,label:"我"}),ce(),void oe(e);q.value=!0,function(e){const a=e.trim(),l=a.includes("出冷汗")||a.includes("恶心")?"有，刚才疼得厉害的时候出了一身冷汗，还有点恶心，但没有吐。":a.includes("体格检查")?"患者面色苍白，额部出汗，心率偏快，血压较入院时略低。":a.includes("辅助检查")?"心电图提示下壁导联 ST 段抬高，肌钙蛋白待回报。":"疼痛主要在胸骨后，像压榨一样，休息后也没有明显缓解。";return Promise.resolve([{id:`doctor-${Date.now()}`,role:"doctor",content:a,label:"我"},{id:`patient-${Date.now()+1}`,role:"patient",content:l,label:"患者"},{id:`mentor-${Date.now()+2}`,role:"mentor",content:"很好，继续围绕 OPQRST 思路追问疼痛诱因、部位、性质、放射、持续时间和缓解因素，同时关注危险信号。",label:"王主任"}])}(e).then((e=>{U.messages.push(...e),ce()})).finally((()=>{q.value=!1}))}}async function oe(e){const a=G.value;if(!a)return;q.value=!0,null==L||L.abort(),L=new AbortController;const l=U.messages.length;U.messages.push({id:`patient-stream-${Date.now()}`,role:"patient",content:"",label:"患者"}),ce();try{await async function(e,a,l,t){var s,n,o;const i=await fetch(`/fastapi/api/v1/sessions/${e}/chat/stream`,{method:"POST",headers:T("text/event-stream"),body:JSON.stringify({message:a}),signal:t});if(!i.ok||!i.body)throw new Error(await P(i));const c=i.body.getReader(),r=new TextDecoder;let u="",d=!1;for(;;){const{value:e,done:a}=await c.read();if(a)break;u+=r.decode(e,{stream:!0});const t=u.split("\n\n");u=t.pop()||"";for(const i of t){const e=null==(s=i.match(/^event:\s*(.+)$/m))?void 0:s[1],a=null==(n=i.match(/^data:\s*(.+)$/m))?void 0:n[1];if(!e||!a)continue;const t=JSON.parse(a);if("message_delta"===e){const e=t.delta;"string"==typeof e&&l.onDelta(e)}else if("message_done"===e)d=!0,null==(o=l.onDone)||o.call(l,t);else if("error"===e)throw new Error("string"==typeof t.message?t.message:"AI 流式回复异常")}}if(!d)throw new Error("AI 流式回复未正常结束，请重试")}(a,e,{onDelta(e){U.messages[l].content+=e,ce()}},L.signal)}catch(t){if(t instanceof DOMException&&"AbortError"===t.name)return;U.messages[l].content.trim()||(U.messages[l].content="AI 病人回复失败，请重试。"),re(t instanceof Error?t.message:"AI 流式回复异常")}finally{q.value=!1,L=null,ce()}}async function ie(){const e=G.value;if(!e)return void re("请先生成模拟场景");if(z.value)return;z.value=!0,null==W||W.abort(),W=new AbortController;const a=U.messages.length;U.messages.push({id:`mentor-hint-${Date.now()}`,role:"mentor",content:"王主任正在生成提示...",label:"王主任"}),ce();try{let l=!1;await async function(e,a,l,t){var s,n,o;const i={last_user_message:a,scope:"current_conversation"},c=await fetch(`/fastapi/api/v1/sessions/${e}/hints/stream`,{method:"POST",headers:T("text/event-stream"),body:JSON.stringify(i),signal:t});if(!c.ok||!c.body)throw new Error(await P(c));const r=c.body.getReader(),u=new TextDecoder;let d="",m=!1;for(;;){const{value:e,done:a}=await r.read();if(a)break;d+=u.decode(e,{stream:!0});const t=d.split("\n\n");d=t.pop()||"";for(const i of t){const e=null==(s=i.match(/^event:\s*(.+)$/m))?void 0:s[1],a=null==(n=i.match(/^data:\s*(.+)$/m))?void 0:n[1];if(!e||!a)continue;const t=JSON.parse(a);if("hint_delta"===e){const e=t.delta;"string"==typeof e&&l.onDelta(e)}else if("hint_done"===e)m=!0,null==(o=l.onDone)||o.call(l,t);else if("error"===e)throw new Error("string"==typeof t.message?t.message:"练习提示生成失败，请稍后重试")}}if(!m)throw new Error("练习提示未正常结束，请重试")}(e,function(){const e=[...U.messages].reverse().find((e=>"doctor"===e.role));return(null==e?void 0:e.content)||"开始问诊"}(),{onDelta(e){l||(U.messages[a].content="",l=!0),U.messages[a].content+=e,ce()}},W.signal)}catch(l){if(l instanceof DOMException&&"AbortError"===l.name)return;U.messages[a].content.trim()&&"王主任正在生成提示..."!==U.messages[a].content||(U.messages[a].content="练习提示生成失败，请稍后重试。"),re(l instanceof Error?l.message:"练习提示生成失败，请稍后重试")}finally{z.value=!1,W=null,ce()}}function ce(){setTimeout((()=>{B.value+=1e3}),60)}function re(e){Q&&clearTimeout(Q),H.value=e,M.value=!0,y({title:e,icon:"none"}),Q=setTimeout((()=>{M.value=!1}),2200)}return n((function(){(function(e){const a=e||A,l="毕波涛"===a.patientName?"陈先生":a.patientName;return Promise.resolve({patient:{name:l,gender:a.gender,age:a.age,department:a.department,chiefComplaint:a.title},stages:[{key:"history",label:"病史采集",active:!0},{key:"diagnosis",label:"初步诊断",active:!1},{key:"treatment",label:"治疗方案",active:!1}],messages:[{id:"patient-initial",role:"patient",content:"心血管内科"===a.department?"医生，我心口这儿针扎一样疼了两个小时了，现在感觉喘气都费劲。":`医生，我这次主要是${a.title}，有点担心。`,label:"患者"},{id:"mentor-initial",role:"mentor",content:"观察患者的面部表情和生命体征。你的第一个问题应该如何询问，以明确疼痛的性质？",label:"王主任"}]})})(I.caseItem).then((a=>{var l;Object.assign(U.patient,a.patient),U.stages=a.stages;const t=function(){const a=e("clinical-thinking-scenario");return a&&"object"==typeof a?a:null}();if(null==(l=null==t?void 0:t.session)?void 0:l.session_id)return G.value=t.session.session_id,U.messages=t.session.patient_opening?[{id:`patient-opening-${t.session.session_id}`,role:"patient",content:t.session.patient_opening,label:"患者"}]:[],ce(),void oe("开始问诊");U.messages=a.messages,ce()}))})),o((()=>{null==L||L.abort(),null==W||W.abort(),Q&&clearTimeout(Q)})),(e,a)=>{const l=k,t=w,s=x,n=$,o=C,y=V,O=D;return R.value?(i(),c(S,{key:0,"case-item":e.caseItem,onOpenSettings:a[0]||(a[0]=e=>j("open-settings")),onOpenProfile:r(N),onGoHome:a[1]||(a[1]=e=>j("go-home"))},null,8,["case-item","onOpenProfile"])):(i(),c(l,{key:1,class:"chat-page"},{default:u((()=>[d(l,{class:"chat-shell"},{default:u((()=>[d(l,{class:"top-nav"},{default:u((()=>[d(t,{class:"icon-button","aria-label":"设置",onClick:a[2]||(a[2]=e=>j("open-settings"))},{default:u((()=>[d(l,{class:"settings-icon"})])),_:1}),d(t,{class:"icon-button 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