Objective: Thermoregulatory dysfunction after spinal cord injury (SCI) impairs quality of life and predisposes persons to life-threatening sequela of heat-related illness (HRI) in conditions of high ambient temperature. SCI clinicians currently have no objective way to predict which persons are at greatest risk of HRI. Evaporative cooling via sweating is the body’s most efficient mechanism of heat dissipation. The relationship between the neurological level of injury (NLOI) and the degree of sudomotor dysfunction is not well defined. This study examines the relationship between the NLOI and sweating level of injury (SwLOI). This information can assist SCI clinicians in identifying individuals with SCI who have most impaired sudomotor function and thus highest risk of HRI.

Design: Observational.

Setting: Human physiology laboratory.

Participants: 10 persons with tetraplegia (TP), 14 with paraplegia (PP) and 10 able-bodied (AB).

Intervention: Passive heat stress (1°C rise in core temperature) with sweat responses (SR) quantified with the starch iodine test.

Outcome measures: The most caudal dermatomal level in which sweating was visualized was recorded as the SwLOI, which was compared to the NLOI. Minimum, maximum and median differences between NLOI and SwLOI were calculated.

Results: Persons with tetraplegia demonstrated no SR. Persons with paraplegia demonstrated SR at a median of 1 level below NLOI. Able-bodied controls demonstrated sweating on all skin surface areas.

Conclusions: Persons with motor complete tetraplegia lack evaporative cooling capacity through SR during passive heat stress predisposing them to HRI. Meanwhile, persons with paraplegia sweat on average 1 dermatomal level below their NLOI.

目的：脊髓损伤 (SCI) 后的体温调节功能障碍会损害生活质量，并使人们在高环境温度条件下容易出现危及生命的热相关疾病 (HRI) 后遗症。SCI 临床医生目前没有客观的方法来预测哪些人患 HRI 的风险最大。通过出汗进行蒸发降温是人体最有效的散热机制。神经损伤水平 (NLOI) 与促汗功能障碍程度之间的关系尚不明确。本研究探讨了 NLOI 与出汗损伤程度 (SwLOI) 之间的关系。这些信息可以帮助 SCI 临床医生识别出 SCI 患者中促汗功能受损最严重，因此 HRI 风险最高的个体。

设计：观察。

地点：人体生理学实验室。

参与者：四肢瘫痪（TP）10人，截瘫（PP）14人，身体健全（AB）10人。

干预：被动热应激（核心温度升高 1°C）和汗液反应 (SR) 用淀粉碘测试量化。

结果测量：将可见出汗的最尾部皮节水平记录为 SwLOI，并将其与 NLOI 进行比较。计算了 NLOI 和 SwLOI 之间的最小、最大和中值差异。

结果：四肢瘫痪者没有表现出 SR。截瘫患者的 SR 中位数低于 NLOI 1 级。身体健全的对照显示所有皮肤表面区域都出汗。

结论：运动完全性四肢瘫痪的人在被动热应激期间缺乏通过 SR 的蒸发冷却能力，使他们易患 HRI。同时，截瘫患者平均出汗低于其 NLOI 1 个皮节水平。