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@@ -0,0 +1,361 @@
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+<?php
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+declare(strict_types=1);
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+
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+namespace app\service;
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+
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+use app\controller\Cdss;
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+use app\controller\PatientAuxiliary;
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+use app\model\CdssDisease;
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+use app\model\CdssInspection;
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+use app\model\CdssXyDisease;
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+use app\model\DiseasesKeyword;
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+use app\model\KnowledgeRule;
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+use app\model\Symptom;
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+use app\model\SymptomDictionary;
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+use think\helper\Arr;
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+
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+require_once app()->getRootPath() . 'vendor/autoload.php';
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+
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+class XyCdssService
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+{
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+ private static $instance;
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+
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+ public static function getInstance(){
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+ if(!self::$instance instanceof self){
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+ self::$instance = new self();
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+ }
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+ return self::$instance;
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+ }
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+
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+
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+ public function getResult($params){
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+
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+ $chief = Arr::get($params,'data.chief',''); //主诉
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+ $presentHistory = Arr::get($params,'data.presentHistory',''); //现病史
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+ $patientBirthday = Arr::get($params,'patientMes.patientBirthday',''); //出生年月
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+ $sex = Arr::get($params,'patientMes.patientGender','');
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+ $age = Arr::get($params,'patientMes.patientAge');
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+
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+ // if($sex == '男性'){
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+ // $sex = 1;
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+ // }elseif($sex == '女性'){
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+ // $sex = 2;
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+ // }else{
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+ // $sex = 0;
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+ // }
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+
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+ $age = $age ?: ($patientBirthday ? date("Y") - explode('-',$patientBirthday)[0] : 0) ;
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+
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+ $result = [];
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+
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+// if($chief){
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+// $dictionary = SymptomDictionary::field('symptom')->whereRaw("'".$chief."'".' LIKE CONCAT("%", symptom, "%")')->select()->toArray();
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+// $chief = $dictionary ? implode(',',array_column($dictionary,'symptom')) : '';
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+// }
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+
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+ $name = '';
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+ if(isset($params['lisAdvices']) || isset($params['pacsAdvices'])){
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+ $name = Arr::get($params,'lisAdvices.0.itemName','') ?: Arr::get($params,'pacsAdvices.0.itemName','');
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+ }if(isset($params['lisCol']) || isset($params['pacsCol'])){
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+ $name = Arr::get($params,'lisCol.0.lisName','') ?: Arr::get($params,'pacsCol.0.examName','');
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+ }
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+
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+ return (new PatientAuxiliary(app()))->savePatientAuxiliaryInfoInterfece([
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+ 'ZYH' => Arr::get($params,'patientMes.treatmentCode',''),
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+ 'ZSZZ' => $chief,
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+ 'name' => $name,
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+ 'tag' => Arr::get($params,'patientMes.patientType','Inspection'),
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+ 'XB' => $sex,
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+ 'NL' => $age,
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+ ]);
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+
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+ /**
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+ * 废弃 ——————————————————————————————————————————————————————————————————————————————————————————
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+ */
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+
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+ /**
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+ * 疑似诊断
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+ */
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+ if($chief){
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+ $res = $this->getCdssXyDisease($chief);
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+ if(empty($res)) $res = $this->getSymptom($chief);
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+
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+ $this->getSexFilter($res,$sex);//根据性别筛选
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+
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+ $res = $this->getAgeFilter($res,$age); //根据年龄筛选
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+
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+ $this->getAboutDiseasesByKeywordCount($res,$chief);
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+ foreach ($res as $k => $v){
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+ //获取鉴别诊断
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+ $res[$k]['antidiastole'] = CdssDisease::where('name' , $v['name'])->value('antidiastole');
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+
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+ //获取检查检验
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+ $disease = CdssXyDisease::where('name',$v['name'])->find();
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+ $inspection = $disease->inspection;
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+ $inspectionList = explode(',', $inspection);
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+ foreach ($inspectionList as $key => $value) {
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+ $res[$k]['inspection_list'][$key]['name'] = $value;
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+ }
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+
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+ //获取治疗方案
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+ $res[$k]['treatment'] = $disease->inspection;
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+ }
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+
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+ $result['suspectedDiagnosis'] = $res;
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+ }
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+
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+ /**
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+ * 鉴别诊断、推荐检查检验、治疗方案
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+ */
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+ if(isset($params['diagnoses'])){
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+ $result['diagnoses'] = $this->diagnoses(Arr::get($params,'diagnoses',[]));
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+ }
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+
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+ /**
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+ * 检查检验合理性判断、
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+ */
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+ if(isset($params['lisAdvices']) || isset($params['pacsAdvices'])){
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+ $result['RationalityCheck'] = $this->pacsLisRationalityCheck(Arr::get($params,'lisAdvices',[]),Arr::get($params,'pacsAdvices',[]),$sex);
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+ }
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+
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+
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+ /**
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+ * 检查检验报告解读、检验检查异常值
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+ */
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+ if(isset($params['lisCol']) || isset($params['pacsCol'])){
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+ $result['ReportInterpretation'] = $this->pacsLisReportInterpretation(Arr::get($params,'lisCol',[]),Arr::get($params,'pacsCol',[]));
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+ }
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+
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+ return $result;
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+ }
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+
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+ /**
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+ * 获取鉴别诊断、推荐检查检验、推荐评估表、治疗方案
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+ * @param $aboutDiseases
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+ * @throws \think\db\exception\DataNotFoundException
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+ * @throws \think\db\exception\DbException
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+ * @throws \think\db\exception\ModelNotFoundException
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+ */
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+ private function diagnoses($aboutDiseases){
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+ foreach ($aboutDiseases as $k => $v){
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+ //获取鉴别诊断
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+ $cdssDisease = CdssDisease::where('name' , $v['name'])->value('antidiastole');
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+ if($cdssDisease){
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+ $aboutDiseases[$k]['antidiastole'] = $cdssDisease;
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+ }else{
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+ $aboutDiseases[$k]['antidiastole'] = '';
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+ }
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+
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+ //获取检查检验
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+ $disease = CdssXyDisease::where('name',$v['name'])->find();
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+ if($disease){
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+ $inspection = $disease->inspection;
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+ $inspectionList = explode(',', $inspection);
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+ foreach ($inspectionList as $key => $value) {
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+ $aboutDiseases[$k]['inspection_list'][$key]['name'] = $value;
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+ }
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+
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+ //获取治疗方案
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+ $aboutDiseases[$k]['treatment'] = $disease->inspection;
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+ }else{
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+ $aboutDiseases[$k]['inspection_list'] = [];
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+ $aboutDiseases[$k]['treatment'] = '';
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+ }
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+ }
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+ return $aboutDiseases;
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+ }
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+
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+ private function pacsLisRationalityCheck($lisAdvices,$pacsAdvices,$sex){
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+ $res['lis_rationality_check'] = $res['pace_rationality_check'] = [];
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+
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+ foreach ($lisAdvices as $val){
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+ $lis_rationality_check = KnowledgeRule::field('name,rule_level,rule_tip')->whereLike('name',"%{$val['itemName']}%")->where('gender',$sex)->find();
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+ if($lis_rationality_check) $res['lis_rationality_check'][] = $lis_rationality_check;
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+ }
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+
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+ foreach ($pacsAdvices as $val){
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+ $pacs_rationality_check = KnowledgeRule::field('name,rule_level,rule_tip')->whereLike('name',"%{$val['itemName']}%")->where('gender',$sex)->find();
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+ if($pacs_rationality_check) $res['pace_rationality_check'][] = $pacs_rationality_check;
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+ }
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+ return $res;
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+ }
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+
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+ private function pacsLisReportInterpretation($lisCol,$pacsCol){
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+ $res['lis_report_interpretation'] = $res['pacs_report_interpretation'] = [];
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+ $field = 'name,overview,principle,reagent,operation,clinicalSignificance,normalValue,annotation,precautions,donghua_name,zhonglian_name,process,related_symptoms,related_diseases,haoze_name,sex';
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+ foreach ($lisCol as $key => $val){
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+ $res['lis_report_interpretation'][$key]['name'] = $val['lisName'];
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+ foreach ($val['lisItems'] as $v) {
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+ $lis_report_interpretation = CdssInspection::field($field)->whereLike('name', "%{$v['itemName']}%")->find();
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+ if ($lis_report_interpretation) {
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+ $res['lis_report_interpretation'][$key]['list'][] = $lis_report_interpretation;
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+ }
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+ }
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+ }
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+
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+ foreach ($pacsCol as $v){
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+ $pacs_report_interpretation = CdssInspection::field($field)->whereLike('name',"%{$v['examName']}%")->find();
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+ if($pacs_report_interpretation){
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+ $res['pacs_report_interpretation'][] = $pacs_report_interpretation;
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+ }
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+ }
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+
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+ return $res;
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+ }
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+
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+
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+ /**
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+ * 疑似诊断
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+ * @param $values
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+ * @return array
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+ * @throws \think\db\exception\DataNotFoundException
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+ * @throws \think\db\exception\DbException
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+ * @throws \think\db\exception\ModelNotFoundException
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+ */
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+ private function getCdssXyDisease($values){
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+ /**
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+ * 从疾病的临床表现属性匹配症状
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+ * 单个或多条件匹配
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+ */
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+ $query = CdssXyDisease::field('name,pathogenesis,clinicalFeature')->where('1=1');
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+
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+ if (stripos($values, ',') !== false) {
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+ $symptoms = explode(',', $values);
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+
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+ // 使用AND连接多个症状条件
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+ foreach ($symptoms as $symptom) {
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+ $query = $query->where('clinicalFeature', 'like', '%' . $symptom . '%');
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+ }
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+
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+ } else {
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+ $query->whereLike('clinicalFeature', '%' . $values . '%');
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+ }
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+ $aboutDiseases = $query->limit(200)->select()->toArray();
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+
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+ return $aboutDiseases;
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+ }
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+
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+
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+ private function getSymptom($values){
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+ $aboutDiseases = [];
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+ if (stripos($values, ',') !== false) {
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+ $symptoms = explode(',', $values);
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+ foreach ($symptoms as $key => $symptom) {
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+ $diseases[] = Symptom::field('disease')->where('name', 'like', $symptom . '%')->select()->toArray();
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+ }
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+ } else {
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+ $diseases = Symptom::field('disease')->whereLike('name', $values . '%')->select()->toArray();
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+ }
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+
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+ if (empty($diseases)) return [];
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+
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+ $diseases = array_column($diseases, 'disease');
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+
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+ foreach ($diseases as $k => $disease) {
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+ $diseases[$k] = str_replace('||', ',', $disease);
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+ }
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+ $diseases = implode(',', $diseases);
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+ $diseasesArr = explode(',', $diseases);
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+
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+ foreach ($diseasesArr as $key => $val){
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+ $aboutDiseases[$key]['name'] = $diseasesArr[$val];
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+ $aboutDiseases[$key]['pathogenesis'] = '';
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+ $aboutDiseases[$key]['clinicalFeature'] = '';
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+ }
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+
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+ return $aboutDiseases ?? [];
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+ }
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+
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+
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+
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+ public function getSexFilter(&$aboutDiseases,$sex){
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+
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+ switch ($sex){
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+ case 2:
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+ $tag = 4;
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+ break;
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+ case 1:
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+ default:
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+ $tag = 3;
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+ break;
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+ }
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+
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+ $sexDiseasesKeywords = DiseasesKeyword::where('tag', $tag)->value('keyword');
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+ if ($sexDiseasesKeywords) {
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+ $sexDiseasesKeywords = explode(',', $sexDiseasesKeywords);
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+ foreach ($aboutDiseases as $k => $v) {
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+ foreach ($sexDiseasesKeywords as $sexDiseasesKeyword) {
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+ if (stripos($v['name'], $sexDiseasesKeyword) !== false) {
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+ unset($aboutDiseases[$k]);
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+ }
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+ }
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+ }
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+ }
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+ }
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+
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+
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+ public function getAgeFilter($aboutDiseases,$age){
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+
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+ $age = (int) $age;
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+ $childDiseasesKeyword = DiseasesKeyword::where('tag', DiseasesKeyword::CHILDTAG)->find();
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+ $oldDiseasesKeyword = DiseasesKeyword::where('tag', DiseasesKeyword::OLDTAG)->find();
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+
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+ $childAboutDiseasesKeyword = $childDiseasesKeyword['keyword'];
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+ $oldAboutDiseasesKeyword = $oldDiseasesKeyword['keyword'];
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+
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+ $ageAboutDiseases = [];
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+ foreach ($aboutDiseases as $k => $v) {
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+ if($age > 14 && $age < 60){
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+ $merge = array_merge($childAboutDiseasesKeyword, $oldAboutDiseasesKeyword);
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+ for ($i = 0; $i < count($merge); $i++) {
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+ if (stripos($v['name'], $merge[$i]) !== false) {
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+ unset($aboutDiseases[$k]);
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+ }
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+ }
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+ $ageAboutDiseases = array_values($aboutDiseases);
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+ }else{
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+ $diseasesKeyword = ($age < 60) ? $childAboutDiseasesKeyword : $oldAboutDiseasesKeyword;
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+ for ($i = 0; $i < count($diseasesKeyword); $i++) {
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+ if (stripos($v['name'], $diseasesKeyword[$i]) !== false) {
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+ $ageAboutDiseases[] = $v;
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+ }
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+ }
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+ }
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+ }
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+ return $ageAboutDiseases;
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+ }
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+
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+
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+ private function getAboutDiseasesByKeywordCount(&$aboutDiseases, $keyword)
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+ {
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+ if (stripos($keyword, ',') !== false) {
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+ foreach ($aboutDiseases as $key => $value) {
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+ $aboutDiseases[$key]['keyword_count'] = $this->getKeywordTotalCount($value['clinicalFeature'], $keyword);
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+ }
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+ } else {
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+ foreach ($aboutDiseases as $key => $value) {
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+ $aboutDiseases[$key]['keyword_count'] = substr_count($value['clinicalFeature'], $keyword);
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+ }
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+ }
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+
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+ if (count($aboutDiseases) > 1) {
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+ $keyword_count = array_column($aboutDiseases, 'keyword_count');
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+ array_multisort($keyword_count, SORT_DESC, $aboutDiseases);
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+ }
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+ }
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+
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+ private function getKeywordTotalCount($clinicalFeature, $keyword): int
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+ {
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+ $keywordArray = array_values(array_filter(explode(',', $keyword)));
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+ $keywordArrayCount = count($keywordArray);
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+
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+ $totalCount = 0;
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+ for ($i = 0; $i < $keywordArrayCount; $i++) {
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+ if ($clinicalFeature) {
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+ $totalCount += substr_count($clinicalFeature, $keywordArray[$i]);
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+ }
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+ }
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+ return $totalCount;
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+ }
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+
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+}
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韩盟盟