feat(health+core+ai): 业务流程全面修复 Phase 4-6 + 集成测试修复

Phase 4 — Dead-letter 重试 + 内容推送 + 安全加固:
- erp-core: retry_dead_letters() 定时重试 + PII payload 脱敏
- erp-core: audit_service 哈希链定时验证 + 写入失败告警
- erp-health: article.published 消费者匹配 patient_tag 推送消息
- erp-health: care_plan 事件消费者 (激活通知 + 完成积分)

Phase 5 — 患者批量操作 + 咨询增强 + 护理事件:
- patient: batch_import_patients + bind_by_phone + refer_patient
- consultation: rate_session 满意度评价 (rating + feedback)
- consent: patient_sign_consent 患者端签署
- validation: source 枚举 (7值) + relationship 枚举 (7值) + 12 单元测试

Phase 6 — 咨询文件上传 + AI 引用标注:
- consultation_message: media_id 附件上传端点
- ai_suggestion: references JSONB + [ref:id] 格式引用标注
- AI system prompt 增加引用指令 + output_parser 提取逻辑

迁移: 000161 (media_id + references) + 000162 (rating + feedback)
集成测试: consultation/follow_up/pii_encryption 新字段同步修复
讨论文档: 2026-05-20-business-process-brainstorm.md (10域审核报告)

crates/erp-ai/src/entity/ai_suggestion.rs

@@ -15,6 +15,7 @@ pub struct Model {
     pub workflow_instance_id: Option<Uuid>,
     pub action_result: Option<serde_json::Value>,
     pub baseline_snapshot: Option<serde_json::Value>,
+    pub references: Option<serde_json::Value>,
     pub reanalysis_id: Option<Uuid>,
     pub created_at: DateTimeUtc,
     pub updated_at: DateTimeUtc,

crates/erp-ai/src/service/analysis.rs

@@ -94,7 +94,12 @@ impl AnalysisService {
 
         tracing::info!(analysis = %analysis_id, tenant = %tenant_id, r#type = %analysis_type.as_str(), "发起 AI 分析");
 
-        // 0.5 知识库上下文注入
+        // 0.5 知识库上下文注入 + 引用标注指令
+        let citation_instruction = "\n\n=== 引用标注规则 ===\n\
+            在回答中引用知识库条目时，请使用 [ref:id] 格式标注引用来源。\n\
+            例如：\"根据临床指南 [ref:uuid-of-guideline]，建议...\"\n\
+            每个引用的知识库条目必须在回答中标注。如果没有引用任何知识库条目，则无需标注。";
+
         let system_prompt = if let Some(ref ks) = self.knowledge_source {
             let query = crate::knowledge::KnowledgeQuery {
                 tenant_id,
@@ -109,9 +114,20 @@ impl AnalysisService {
                         confidence = ctx.confidence,
                         "知识库上下文注入"
                     );
+                    // 将引用的来源 ID 附加到上下文中
+                    let refs_info = if ctx.references.is_empty() {
+                        String::new()
+                    } else {
+                        let refs_list: Vec<String> = ctx
+                            .references
+                            .iter()
+                            .map(|r| format!("- {} (ID: {})", r.title, r.source))
+                            .collect();
+                        format!("\n\n可用引用源:\n{}", refs_list.join("\n"))
+                    };
                     format!(
-                        "{}\n\n=== 知识库参考 ===\n{}",
-                        system_prompt, ctx.context_text
+                        "{}\n\n=== 知识库参考 ===\n{}{}{}",
+                        system_prompt, ctx.context_text, refs_info, citation_instruction
                     )
                 }
                 Ok(_) => system_prompt,
@@ -121,7 +137,8 @@ impl AnalysisService {
                 }
             }
         } else {
-            system_prompt
+            // 无知识库时也添加引用指令（供通用场景使用）
+            format!("{}{}", system_prompt, citation_instruction)
         };
 
         // 1. 渲染 Prompt

crates/erp-ai/src/service/output_parser.rs

@@ -32,6 +32,29 @@ fn extract_section<'a>(raw: &'a str, start: &str, end: &str) -> Option<&'a str>
     Some(&raw[content_start..content_end])
 }
 
+/// 从 AI 输出文本中提取 [ref:id] 格式的引用标注。
+/// 返回所有匹配的引用 ID 列表（去重）。
+pub fn extract_references(text: &str) -> Vec<String> {
+    let re = regex_lite::Regex::new(r"\[ref:([a-f0-9-]+)\]").unwrap_or_else(|_| {
+        // fallback: 不应该发生，但确保不 panic
+        panic!("引用提取正则编译失败");
+    });
+    let mut refs: Vec<String> = re
+        .captures_iter(text)
+        .filter_map(|cap| cap.get(1).map(|m| m.as_str().to_string()))
+        .collect();
+    refs.dedup();
+    refs
+}
+
+/// 从 AI 输出文本中移除 [ref:id] 标注，返回纯文本。
+pub fn strip_references(text: &str) -> String {
+    let re = regex_lite::Regex::new(r"\[ref:[a-f0-9-]+\]").unwrap_or_else(|_| {
+        panic!("引用清除正则编译失败");
+    });
+    re.replace_all(text, "").to_string()
+}
+
 #[cfg(test)]
 mod tests {
     use super::*;
@@ -78,4 +101,47 @@ mod tests {
         assert!(!RiskLevel::Medium.is_auto_executable());
         assert!(!RiskLevel::High.is_auto_executable());
     }
+
+    // --- extract_references ---
+    #[test]
+    fn extract_single_reference() {
+        let text = "根据临床指南 [ref:01234567-abcd-ef01-2345-678901234567]，建议...";
+        let refs = extract_references(text);
+        assert_eq!(refs.len(), 1);
+        assert_eq!(refs[0], "01234567-abcd-ef01-2345-678901234567");
+    }
+
+    #[test]
+    fn extract_multiple_references() {
+        let text = "参考 [ref:aaa-bbb] 和 [ref:ccc-ddd]，综合建议";
+        let refs = extract_references(text);
+        assert_eq!(refs.len(), 2);
+    }
+
+    #[test]
+    fn extract_no_references() {
+        let text = "纯文本，无引用标注";
+        let refs = extract_references(text);
+        assert!(refs.is_empty());
+    }
+
+    #[test]
+    fn extract_dedup_references() {
+        let text = "[ref:aaa-bbb] 再次引用 [ref:aaa-bbb]";
+        let refs = extract_references(text);
+        assert_eq!(refs.len(), 1);
+    }
+
+    #[test]
+    fn strip_references_removes_markers() {
+        let text = "根据指南 [ref:aaa-bbb]，建议复查";
+        let clean = strip_references(text);
+        assert_eq!(clean, "根据指南 ，建议复查");
+    }
+
+    #[test]
+    fn strip_no_references_unchanged() {
+        let text = "无标注文本";
+        assert_eq!(strip_references(text), text);
+    }
 }

crates/erp-ai/src/service/post_process.rs

@@ -34,6 +34,14 @@ pub async fn post_process_analysis(
         structured: None,
     });
 
+    // 1.5 从完整 AI 输出中提取 [ref:id] 引用标注
+    let extracted_refs = output_parser::extract_references(full_content);
+    let references_json = if extracted_refs.is_empty() {
+        None
+    } else {
+        Some(serde_json::json!(extracted_refs))
+    };
+
     // 2. 构建事件 payload
     let mut event_payload = serde_json::json!({
         "analysis_id": analysis_id,
@@ -42,6 +50,10 @@ pub async fn post_process_analysis(
         "doctor_id": user_id,
     });
 
+    if !extracted_refs.is_empty() {
+        event_payload["reference_count"] = serde_json::json!(extracted_refs.len());
+    }
+
     let mut risk_level_str: Option<String> = None;
     let mut suggestion_ids = Vec::new();
 
@@ -50,7 +62,7 @@ pub async fn post_process_analysis(
         event_payload["risk_level"] = serde_json::json!(structured.risk_level.as_str());
         event_payload["suggestion_count"] = serde_json::json!(structured.suggestions.len());
 
-        // 3. 创建建议记录
+        // 3. 创建建议记录（附带引用信息）
         if !structured.suggestions.is_empty() {
             match SuggestionService::create_suggestions(
                 &state.db,
@@ -60,6 +72,7 @@ pub async fn post_process_analysis(
                 structured.risk_level,
                 &structured.baseline_summary,
                 Some(user_id),
+                references_json.as_ref(),
             )
             .await
             {

crates/erp-ai/src/service/suggestion.rs

@@ -8,6 +8,7 @@ pub struct SuggestionService;
 
 impl SuggestionService {
     /// 批量创建建议记录
+    #[allow(clippy::too_many_arguments)]
     pub async fn create_suggestions(
         db: &sea_orm::DatabaseConnection,
         tenant_id: Uuid,
@@ -16,6 +17,7 @@ impl SuggestionService {
         risk_level: RiskLevel,
         baseline_snapshot: &serde_json::Value,
         created_by: Option<Uuid>,
+        references: Option<&serde_json::Value>,
     ) -> AppResult<Vec<uuid::Uuid>> {
         let mut ids = Vec::new();
         for s in suggestions {
@@ -31,6 +33,7 @@ impl SuggestionService {
                 workflow_instance_id: Set(None),
                 action_result: Set(None),
                 baseline_snapshot: Set(Some(baseline_snapshot.clone())),
+                references: Set(references.cloned()),
                 reanalysis_id: Set(None),
                 created_by: Set(created_by),
                 updated_by: Set(created_by),