目的：提 高 对 新 型 冠 状 病 毒 感 染 后 渗 透 性 脱 髓 鞘 综 合 征（osmotic demyelination syndrome，ODS）的认识。

方法：回顾性描述 4 例新型冠状病毒感染后 ODS 患者的临床表现和影像学特点，并复习相关文献进行分析。

结果：4例患者均为新型冠状病毒感染后出现严重低钠血症和过度纠正，临床表现为发热、呕吐、意识障碍、抽搐和运动障碍等，头颅MRI检查早期无异常，2～3周后出现脑桥外伴或不伴脑桥异常信号，予以丙种球蛋白、类固醇及血浆置换等治疗，2例患者预后良好，2例患者预后较差。

结论：新型冠状病毒感染后ODS风险较高，可能与合并低钠血症后24 h内补钠过快有关，也可能与高血压、利尿药使用致血容量不足有关。补钠过程中应密切监测血钠变化，一旦患者出现意识障碍等相关症状，或者头颅MRI检查提示病灶涉及皮质，则应采取更加积极的免疫治疗和适当的护理措施。

Object: To improve the understanding of osmotic demyelination syndrome (ODS) after coronavirus disease 2019 (COVID-19) infection.

Method: The clinical manifestations and imaging features of 4 patients with ODS after COVID-19 infection were retrospectively described, and the related literatures were reviewed and analyzed.

Results: All 4 patients suffered from severe hyponatremia and overcorrection after COVID19 infection, with clinical manifestations including fever, vomiting, disturbance of consciousness, convulsions and movement disorders. No abnormalities were found in head MRI examination the early stage of the disease, and extrapontine lesions with or without pontine involvement appeared after 2-3 weeks. The patients were treated with gammaglobulin, steroids and plasmapheresis. Two patients achieved favorable outcomes, while the other two had poor prognoses.

Conclusion: Patients with COVID-19 infection are at high risk of ODS, which may be related to overly rapid sodium supplementation within 24 hours in the context of pre-existing hyponatremia. Other contributing factors include hypertension and hypovolemia induced by diuretic use. Close monitoring of serum sodium levels is essential during sodium supplementation. If the patient exhibits symptoms such as altered consciousness or head MRI suggests lesions involving the cortex, more aggressive immunotherapy and appropriate nursing measures should be taken.