GY_zhishiku/neo4jApi/app/service/XyCdssService.php

<?php
declare(strict_types=1);

namespace app\service;

use app\controller\Cdss;
use app\controller\PatientAuxiliary;
use app\model\CdssDisease;
use app\model\CdssInspection;
use app\model\CdssXyDisease;
use app\model\DiseasesKeyword;
use app\model\KnowledgeRule;
use app\model\Symptom;
use app\model\SymptomDictionary;
use think\helper\Arr;

require_once app()->getRootPath() . 'vendor/autoload.php';

class XyCdssService
{
    private static $instance;

    public static function getInstance(){
        if(!self::$instance instanceof self){
            self::$instance = new self();
        }
        return self::$instance;
    }


    public function getResult($params){

        $chief = Arr::get($params,'data.chief',''); //主诉
        $presentHistory = Arr::get($params,'data.presentHistory',''); //现病史
        $patientBirthday = Arr::get($params,'patientMes.patientBirthday',''); //出生年月
        $sex = Arr::get($params,'patientMes.patientGender','');
        $age = Arr::get($params,'patientMes.patientAge');

        // if($sex == '男性'){
        //     $sex = 1;
        // }elseif($sex == '女性'){
        //     $sex = 2;
        // }else{
        //     $sex = 0;
        // }

        $age = $age ?: ($patientBirthday ? date("Y") - explode('-',$patientBirthday)[0] : 0) ;

        $result = [];

//        if($chief){
//            $dictionary = SymptomDictionary::field('symptom')->whereRaw("'".$chief."'".' LIKE CONCAT("%", symptom, "%")')->select()->toArray();
//            $chief = $dictionary ? implode(',',array_column($dictionary,'symptom')) : '';
//        }

        $name = '';
        if(isset($params['lisAdvices']) || isset($params['pacsAdvices'])){
            $name = Arr::get($params,'lisAdvices.0.itemName','') ?: Arr::get($params,'pacsAdvices.0.itemName','');
        }if(isset($params['lisCol']) || isset($params['pacsCol'])){
            $name = Arr::get($params,'lisCol.0.lisName','') ?: Arr::get($params,'pacsCol.0.examName','');
        }

        return (new PatientAuxiliary(app()))->savePatientAuxiliaryInfoInterfece([
            'ZYH' => Arr::get($params,'patientMes.treatmentCode',''),
            'ZSZZ' => $chief,
            'name' => $name,
            'tag' => Arr::get($params,'patientMes.patientType','Inspection'),
            'XB' => $sex,
            'NL' => $age,
        ]);

        /**
         * 废弃 ——————————————————————————————————————————————————————————————————————————————————————————
         */

        /**
         * 疑似诊断
         */
        if($chief){
            $res = $this->getCdssXyDisease($chief);
            if(empty($res)) $res = $this->getSymptom($chief);

            $this->getSexFilter($res,$sex);//根据性别筛选

            $res = $this->getAgeFilter($res,$age); //根据年龄筛选

            $this->getAboutDiseasesByKeywordCount($res,$chief);
            foreach ($res as $k => $v){
                //获取鉴别诊断
                $res[$k]['antidiastole'] = CdssDisease::where('name' , $v['name'])->value('antidiastole');

                //获取检查检验
                $disease = CdssXyDisease::where('name',$v['name'])->find();
                $inspection = $disease->inspection;
                $inspectionList = explode(',', $inspection);
                foreach ($inspectionList as $key => $value) {
                    $res[$k]['inspection_list'][$key]['name'] = $value;
                }

                //获取治疗方案
                $res[$k]['treatment'] = $disease->inspection;
            }

            $result['suspectedDiagnosis'] = $res;
        }

        /**
         * 鉴别诊断、推荐检查检验、治疗方案
         */
        if(isset($params['diagnoses'])){
            $result['diagnoses'] = $this->diagnoses(Arr::get($params,'diagnoses',[]));
        }

        /**
         * 检查检验合理性判断、
         */
        if(isset($params['lisAdvices']) || isset($params['pacsAdvices'])){
            $result['RationalityCheck'] = $this->pacsLisRationalityCheck(Arr::get($params,'lisAdvices',[]),Arr::get($params,'pacsAdvices',[]),$sex);
        }


        /**
         * 检查检验报告解读、检验检查异常值
         */
        if(isset($params['lisCol']) || isset($params['pacsCol'])){
            $result['ReportInterpretation'] = $this->pacsLisReportInterpretation(Arr::get($params,'lisCol',[]),Arr::get($params,'pacsCol',[]));
        }

        return $result;
    }

    /**
     * 获取鉴别诊断、推荐检查检验、推荐评估表、治疗方案
     * @param $aboutDiseases
     * @throws \think\db\exception\DataNotFoundException
     * @throws \think\db\exception\DbException
     * @throws \think\db\exception\ModelNotFoundException
     */
    private function diagnoses($aboutDiseases){
        foreach ($aboutDiseases as $k => $v){
            //获取鉴别诊断
            $cdssDisease = CdssDisease::where('name' , $v['name'])->value('antidiastole');
            if($cdssDisease){
                $aboutDiseases[$k]['antidiastole'] = $cdssDisease;
            }else{
                $aboutDiseases[$k]['antidiastole'] = '';
            }

            //获取检查检验
            $disease = CdssXyDisease::where('name',$v['name'])->find();
            if($disease){    
                $inspection = $disease->inspection;
                $inspectionList = explode(',', $inspection);
                foreach ($inspectionList as $key => $value) {
                    $aboutDiseases[$k]['inspection_list'][$key]['name'] = $value;
                }

                //获取治疗方案
                $aboutDiseases[$k]['treatment'] = $disease->inspection;
            }else{
                $aboutDiseases[$k]['inspection_list'] = [];
                $aboutDiseases[$k]['treatment'] = '';
            }
        }
        return $aboutDiseases;
    }

    private function pacsLisRationalityCheck($lisAdvices,$pacsAdvices,$sex){
        $res['lis_rationality_check'] = $res['pace_rationality_check'] = [];

        foreach ($lisAdvices as $val){
            $lis_rationality_check = KnowledgeRule::field('name,rule_level,rule_tip')->whereLike('name',"%{$val['itemName']}%")->where('gender',$sex)->find();
            if($lis_rationality_check) $res['lis_rationality_check'][] = $lis_rationality_check;
        }

        foreach ($pacsAdvices as $val){
            $pacs_rationality_check = KnowledgeRule::field('name,rule_level,rule_tip')->whereLike('name',"%{$val['itemName']}%")->where('gender',$sex)->find();
            if($pacs_rationality_check) $res['pace_rationality_check'][] = $pacs_rationality_check;
        }
        return $res;
    }

    private function pacsLisReportInterpretation($lisCol,$pacsCol){
        $res['lis_report_interpretation'] = $res['pacs_report_interpretation'] = [];
        $field = 'name,overview,principle,reagent,operation,clinicalSignificance,normalValue,annotation,precautions,donghua_name,zhonglian_name,process,related_symptoms,related_diseases,haoze_name,sex';
        foreach ($lisCol as $key => $val){
            $res['lis_report_interpretation'][$key]['name'] = $val['lisName'];
            foreach ($val['lisItems'] as $v) {
                $lis_report_interpretation = CdssInspection::field($field)->whereLike('name', "%{$v['itemName']}%")->find();
                if ($lis_report_interpretation) {
                    $res['lis_report_interpretation'][$key]['list'][] = $lis_report_interpretation;
                }
            }
        }

        foreach ($pacsCol as $v){
            $pacs_report_interpretation = CdssInspection::field($field)->whereLike('name',"%{$v['examName']}%")->find();
            if($pacs_report_interpretation){
                $res['pacs_report_interpretation'][] = $pacs_report_interpretation;
            }
        }

        return $res;
    }


    /**
     * 疑似诊断
     * @param $values
     * @return array
     * @throws \think\db\exception\DataNotFoundException
     * @throws \think\db\exception\DbException
     * @throws \think\db\exception\ModelNotFoundException
     */
    private function getCdssXyDisease($values){
        /**
         * 从疾病的临床表现属性匹配症状
         * 单个或多条件匹配
         */
        $query = CdssXyDisease::field('name,pathogenesis,clinicalFeature')->where('1=1');

        if (stripos($values, ',') !== false) {
            $symptoms = explode(',', $values);

            // 使用AND连接多个症状条件
            foreach ($symptoms as $symptom) {
                $query = $query->where('clinicalFeature', 'like', '%' . $symptom . '%');
            }

        } else {
            $query->whereLike('clinicalFeature', '%' . $values . '%');
        }
        $aboutDiseases = $query->limit(200)->select()->toArray();

        return $aboutDiseases;
    }


    private function getSymptom($values){
        $aboutDiseases = [];
        if (stripos($values, ',') !== false) {
            $symptoms = explode(',', $values);
            foreach ($symptoms as $key => $symptom) {
                $diseases[] = Symptom::field('disease')->where('name', 'like', $symptom . '%')->select()->toArray();
            }
        } else {
            $diseases = Symptom::field('disease')->whereLike('name', $values . '%')->select()->toArray();
        }

        if (empty($diseases)) return [];

        $diseases = array_column($diseases, 'disease');

        foreach ($diseases as $k => $disease) {
            $diseases[$k] = str_replace('||', ',', $disease);
        }
        $diseases = implode(',', $diseases);
        $diseasesArr = explode(',', $diseases);

        foreach ($diseasesArr as $key => $val){
            $aboutDiseases[$key]['name'] = $diseasesArr[$val];
            $aboutDiseases[$key]['pathogenesis'] = '';
            $aboutDiseases[$key]['clinicalFeature'] = '';
        }

        return $aboutDiseases ?? [];
    }



    public function getSexFilter(&$aboutDiseases,$sex){

        switch ($sex){
            case 2:
                $tag = 4;
                break;
            case 1:
            default:
                $tag = 3;
                break;
        }
        
        $sexDiseasesKeywords = DiseasesKeyword::where('tag', $tag)->value('keyword');
        if ($sexDiseasesKeywords) {
            $sexDiseasesKeywords = explode(',', $sexDiseasesKeywords);
            foreach ($aboutDiseases as $k => $v) {
                foreach ($sexDiseasesKeywords as $sexDiseasesKeyword) {
                    if (stripos($v['name'], $sexDiseasesKeyword) !== false) {
                        unset($aboutDiseases[$k]);
                    }
                }
            }
        }
    }


    public function getAgeFilter($aboutDiseases,$age){

        $age = (int) $age;
        $childDiseasesKeyword = DiseasesKeyword::where('tag', DiseasesKeyword::CHILDTAG)->find();
        $oldDiseasesKeyword = DiseasesKeyword::where('tag', DiseasesKeyword::OLDTAG)->find();

        $childAboutDiseasesKeyword = $childDiseasesKeyword['keyword'];
        $oldAboutDiseasesKeyword = $oldDiseasesKeyword['keyword'];

        $ageAboutDiseases = [];
        foreach ($aboutDiseases as $k => $v) {
            if($age > 14 && $age < 60){
                $merge = array_merge($childAboutDiseasesKeyword, $oldAboutDiseasesKeyword);
                for ($i = 0; $i < count($merge); $i++) {
                    if (stripos($v['name'], $merge[$i]) !== false) {
                        unset($aboutDiseases[$k]);
                    }
                }
                $ageAboutDiseases = array_values($aboutDiseases);
            }else{
                $diseasesKeyword = ($age < 60) ? $childAboutDiseasesKeyword : $oldAboutDiseasesKeyword;
                for ($i = 0; $i < count($diseasesKeyword); $i++) {
                    if (stripos($v['name'], $diseasesKeyword[$i]) !== false) {
                        $ageAboutDiseases[] = $v;
                    }
                }
            }
        }
        return $ageAboutDiseases;
    }


    private function getAboutDiseasesByKeywordCount(&$aboutDiseases, $keyword)
    {
        if (stripos($keyword, ',') !== false) {
            foreach ($aboutDiseases as $key => $value) {
                $aboutDiseases[$key]['keyword_count'] = $this->getKeywordTotalCount($value['clinicalFeature'], $keyword);
            }
        } else {
            foreach ($aboutDiseases as $key => $value) {
                $aboutDiseases[$key]['keyword_count'] = substr_count($value['clinicalFeature'], $keyword);
            }
        }

        if (count($aboutDiseases) > 1) {
            $keyword_count = array_column($aboutDiseases, 'keyword_count');
            array_multisort($keyword_count, SORT_DESC, $aboutDiseases);
        }
    }

    private function getKeywordTotalCount($clinicalFeature, $keyword): int
    {
        $keywordArray = array_values(array_filter(explode(',', $keyword)));
        $keywordArrayCount = count($keywordArray);

        $totalCount = 0;
        for ($i = 0; $i < $keywordArrayCount; $i++) {
            if ($clinicalFeature) {
                $totalCount += substr_count($clinicalFeature, $keywordArray[$i]);
            }
        }
        return $totalCount;
    }

}