An 18-year-old man crashes while snowboarding. He is helicoptered to a level 1 trauma center. En route, he receives 2 liters normal saline. At the trauma center’s emergency department, he is found to have a C5 comminuted fracture with spinal cord injury at the same level. Vital signs are: heart rate 80 beats/min, blood pressure 90/50 mmHg, respiratory rate 16 breaths/min, and oxygen saturation 96% on two liters. On neurologic examination, he follows commands, and there is no aphasia or neglect. Glasgow Coma Scale score is 15. Cranial nerves are normal. Motor examination reveals motor-related cortical potentials 0/5 upper extremities and lower extremities, and no reflexes. Rectal sphincter tone is decreased, and sensation is lost in perineal area and up to the C5 dermatome.
In the ensuing hours, he is most likely to lose which of the following functions?
A. Urinary output
B. Respiratory drive
C. Temperature regulation
D. Sacralsparing
E. Consciousness
答案解析：
该患者患有 C5 脊髓损伤，有脊髓休克的证据。 由于 C5 水平孤立的脊髓损伤，他仍然具有 C4 功能（膈神经）。 由于脊髓水肿扩散，他最有可能失去呼吸动力，因此必须监测他的呼吸失代偿。 尽管他看起来血流动力学稳定，但随后数小时脊髓休克的典型特征是反射消失、低血压和心动过缓。 在没有头部受伤的情况下，他不会有因脑损伤而失去意识或体温调节的风险。 由于脊髓损伤程度较高，根据神经系统检查，他没有保留骶骨。
正确答案：B
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