目的:探讨影响阿替普酶静脉溶栓治疗急性缺血性卒中早期疗效的因素。方法:回顾性分析2010年11月至2014年11月我院接受阿替普酶静脉(rt-PA)溶栓治疗的49例急性缺血性卒中患者的临床数据,根据美国国立卫生研究院神经功能缺损评分(NIHSS评分),溶栓后24h评分减少超过3分为溶栓早期有效组(24例),否则为溶栓早期无效组(25例),比较两组各临床数据的差异。结果:两组患者性别、年龄、吸烟史、酗酒史、高血压病史、糖尿病史、溶栓前血糖、血生化、血压等均无差异(P>0.05);早期有效组患者房颤发生率、脑白质病变发生率和溶栓前NIHSS评分较早期无效组低,差异均有统计学意义(P<0.05);早期有效组患者90天生活自理率较早期无效组高,差异有统计学意义(P<0.05)。结论:阿替普酶静脉溶栓后早期疗效好者3个月预后好;溶栓前无房颤、无白质疏松患者溶栓后早期疗效好。 Objective: To explore the factors influencing the early curative effect of intravenous thrombolysis with alteplase in acute ischemic stroke. Methods: The clinical data of 49 acute ischemic stroke patients treated with intravenous alteplase (rt-PA) in our hospital from November 2010 to November 2014 were retrospectively analyzed. According to the results of the National Institute of Health (NIHSS score). The score of thrombolytic therapy was reduced by more than 3 points at 24 hours after thrombolytic therapy (24 cases). Otherwise, there was no effect of early thrombolytic therapy (25 cases). The differences of clinical data between the two groups were compared. Results: There was no significant difference in gender, age, smoking history, alcohol abuse history, history of hypertension, history of diabetes mellitus, blood glucose before thrombolysis, blood biochemistry and blood pressure between the two groups (P> 0.05) The incidence of white matter lesions and NIHSS score before thrombolysis were significantly lower than those of the early invalid group (P <0.05). The self-care rate of 90-days early-active group was higher than that of the early invalid group (P <0.05), and the difference was statistically significant P <0.05). CONCLUSION: Good early prognosis is obtained in 3 months after intravenous infusion of alteplase. There is no atrial fibrillation before thrombolysis, and the early curative effect after thrombolysis in patients without leucoma is good.