目的 在性别视角下，调查ICU患者转出ICU后3个月内ICU后综合征（post-intensive care syndrome，PICS）认知、生理、心理领域功能障碍的纵向关系，明确性别的调节作用。 方法 采用便利抽样法，选取2023年9月—2024年2月在山东省某三级甲等医院内科、外科ICU收治并成功转出的584例危重症患者作为研究对象，按性别进行分组，对其转出ICU后1个月（T1）和3个月（T2）的认知、生理、心理功能障碍状况进行评估。构建交叉滞后模型探索PICS 3个领域的纵向关系及性别差异。 结果 两次随访的PICS严重程度有下降趋势（Z=-7.431，P<0.01），且该趋势在不同性别群体中一致。认知、生理、心理功能障碍之间的纵向关系通过自回归效应稳定维持（β=0.55、0.51、0.39），认知、生理、心理功能障碍水平在两次评估中均呈正相关。交叉滞后模型分析显示，T1时的认知功能障碍对T2时的生理功能障碍的预测作用在男女群体中均有具有统计学意义。T1时的生理功能障碍对T2时的认知和心理功能障碍的预测仅在男性中有统计学意义。 结论 ICU患者转出ICU后3个月内的认知、生理、心理功能障碍在不同性别中有不同的纵向关系。基于性别对ICU患者进行早期、针对性的干预可有效预防后期功能障碍的发生、维持和恶化。

Objective From a gender perspective，to investigate the longitudinal relationships between cognitive，physical，and psychological dysfunction of post-intensive care syndrome（PICS）among ICU survivors within 3 months after being transferred out of the ICU，and clarify the moderating role of gender. Methods 584 critically ill patients transferred from medical and surgical ICUs of a tertiary grade-A hospital in Shandong Province（September 2023-February 2024） was included by convenient sampling. They were grouped by gender，and their cognitive，physical，and psychological dysfunction were assessed at 1 month （T1） and 3 months （T2） post-ICU discharge. A cross-hysteresis model was constructed to explore the longitudinal relationship and gender difference between the three domains of PICS. Results The severity of PICS at the two follow-ups showed a downward trend（Z=-7.431，P <0.01），and this trend was consistent among different gender groups. Autoregressive effects stably maintained longitudinal relationships among the three dysfunctions（β=0.55，0.51，0.39），with positive correlations observed at both time points. Cross-lagged analysis revealed that T1 cognitive impairment significantly predicted T2 physical impairment in both male and female groups. T1 physical impairment significantly predicted T2 cognitive and psychological impairments only in males. Conclusion Longitudinal relationships between cognitive，physical，and psychological impairments vary by sex within 3 months post-ICU discharge. Early and targeted interventions based on gender for ICU patients can effectively prevent the occurrence，maintenance，and deterioration of functional disorders in the later stages.