目的　研究经血管内选择性溶栓治疗 49例 8h内发病的急性脑梗死患者 ,以评估动脉内溶栓治疗急性脑梗死的疗效。方法　患者均急诊行头颅CT检查 ,31例经股动脉插管 ,全脑血管造影确认脑梗死 ,再选择性将导管插入患侧颈内动脉和椎动脉并注入尿激酶 5 0～ 75万单位行接触性和区域性溶栓治疗。对照组 18例行常规治疗。结果　溶栓后血管再通率为 71% ,有效率为 83%。 2 3例颈内动脉系和 4例椎基动脉系梗死在溶栓后 2周内神经损害体征明显改善 ,2例死亡。溶栓组改良爱丁堡 斯堪的纳维亚脑卒中量表 (MESSS)评分改善 (2 1.6± 13.6 )分 ;对照组改善 (5 .9± 5 .3)分。溶栓组发病时间越短其疗效越好。结论　选择性动脉内溶栓治疗是一种治疗急性脑梗死的有效方法 ,具有较高的血管再通率 Objective To study the efficacy and safety of intra-arterial thrombolysis in the treatment of acute cerebral infarction in 49 patients with acute cerebral infarction within 8 hours after selective thrombolytic therapy. Methods All patients underwent emergency head CT scans, 31 cases of femoral artery catheterization, cerebral angiography confirmed cerebral infarction, and then selectively inserted into the ipsilateral internal carotid artery and vertebral artery and injection of urokinase 500 to 750 000 units Contact and regional thrombolytic therapy. Control group of 18 routine treatment. Results The rate of recanalization after thrombolysis was 71% and the effective rate was 83%. In 23 cases of internal carotid artery and 4 cases of vertebral artery infarction, signs of neurological damage were significantly improved within 2 weeks after thrombolysis and 2 died. Thrombolysis improved The Scandinavian Stroke Scale (MESSS) scores improved (2 1.6 ± 13.6) points; control group improved (5 .9 ± 5 .3) points. The shorter the onset of thrombolytic therapy, the better its efficacy. Conclusion Selective intra-arterial thrombolysis is an effective treatment for acute cerebral infarction with high revascularization rate