目的 比较低剂量与标准剂量阿替普酶静脉溶栓治疗急性脑梗死的有效性和安全性。方法 2014年7月-2018年7月中国人民解放军海军总医院收治的接受阿替普酶静脉溶栓治疗的急性脑梗死患者237例为研究对象，随机分为低剂量组（120例）和标准剂量组（117例）。所有患者在发病4.5 h内均给予注射用阿替普酶静脉溶栓治疗，低剂量组给予0.6 mg/kg，15%快速静脉推注，85%静脉泵输注，持续60 min，最大剂量60 mg。标准剂量组0.9 mg/kg，10%快速静脉推注，90%静脉泵输注，持续60 min，最大剂量90 mg。观察两组的临床疗效，比较两组NIHSS评分、mRS评分、7 d内症状性颅内出血情况。结果 标准剂量组和低剂量组的总有效率分别是86.32%、85.83%，两组比较差异没有统计学意义。溶栓后各时间点两组NIHSS评分比较差异均无统计学意义。总体而言，两组NIHSS评分均随时间推移呈下降趋势，同组患者在不同时间段的变化差异有统计学意义（P<0.05）。90 d时mRS评分0~1分和2、3、4、5、6分的患者例数两组比较差异无统计学意义；两组7 d内症状性颅内出血的发生例数比较差异无统计学意义。结论 低剂量阿替普酶静脉溶栓治疗急性脑梗死患者的疗效和安全性与标准剂量相当，低剂量阿替普酶可减轻患者的经济负担，节省宝贵的医疗资源，具有一定的临床推广应用价值。

Objective To compare the clinical effect and safety of low-dose and standard-dose alteplase in treatment of acute cerebral infarction. Methods Patients (237 cases) with acute cerebral infarction in the Chinese People's Liberation Army Navy General Hospital from July 2014 to July 2018 were divided into low-dose (120 cases) and standard-dose alteplase groups (117 cases). All patients were performed with alteplase within 4.5 h. Low-dose group was given 0.6 mg/kg, 15% was for rapid intravenous injection, 85% was for intravenous infusion pump for 60 min, and the maximum dose was 60 mg. Standard-dose group was given 0.9 mg/kg, 10% was for rapid intravenous injection, 90% was for intravenous infusion pump for 60 min, and the maximum dose was 90 mg. After treatment, the clinical efficacy was evaluated, and the changes of NIHSS score, mRS score, and symptomatic intracranial bleeding within 7 d in two groups were compared. Results After treatment, the clinical efficacy in the standard-dose and low-dose groups were 86.32% and 85.83%, and there was no differences between two groups. NIHSS score in each time point after thrombolysis was similar between the two groups, and there was no statistical significance. In general, NIHSS scores in two groups were declining over time, and there were differences in the same group (P<0.05). mRS score of 0-1, 2, 3, 4, 5, and 6 within 90 d had no statistical significance between the two groups, and the cases of symptomatic intracranial bleeding within 7 d had no statistically significant difference between two groups. Conclusions The efficacy and safety of low dose alteplase at venous thrombolysis in treatment of acute cerebral infarction were similar to the standard-dose alteplase, and low doses alteplase can reduce the economic burden of patients, and also can save precious health resources, which has a certain clinical application value.