目的 观察阿替普酶治疗老年患者急性脑梗死的临床疗效和安全性。方法 2011年6月—2013年6月在天津市第一中心医院住院的老年急性脑梗死患者80例随机分为治疗组（40例）和对照组（40例）。治疗组给予阿替普酶0.9 mg/kg，总剂量的10%静脉推注，剩余剂量在随后60 min内持续静脉滴注，24 h后经头颅CT证实患者有无出血。对照组口服拜阿司匹林，300 mg/次，1次/d，两组均持续治疗7 d。在两组患者治疗前、治疗后1、3 、7、30、90 d进行欧洲卒中神经功能缺损程度（ESS）评分和Barthel指数评分。结果 两组治疗后患者神经功能均得到不同程度的改善，和治疗前相比，两组患者治疗后3、7、30、90 d的ESS平均值均较治疗前有显著提高，治疗前后差异有统计学意义（P＜0.05）；治疗后，治疗组较对照组升高更明显，两组差异有统计学意义（P＜0.05）。两组治疗后Barthel指数较治疗前均明显提高，治疗前后差异有统计学意义（P＜0.05）；治疗1 d后两组Barthel指数差异无统计学意义，但治疗3、7、30、90 d后治疗组Barthel指数平均值明显高于对照组，差异有统计学意义（P＜0.05）。结论 阿替普酶治疗老年患者急性脑梗死能够显著改善进展性脑梗死患者的神经功能缺损症状，提高日常生活活动能力，疗效显著。

Objective To evaluate the clinical efficacy and safety of thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA, Alteplase) for senile patients with acute cerebral infarction. Methods From June 2011 to June 2013, 80 elderly patients diagnosed with acute cerebral infarction in Tianjin First Central Hospital were randomly devided into treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rt-PA at 0.9 mg/kg dosage, 10% of total dose was iv injected and the remaining was iv dripped within the following 60 min. Cranial CT was performed to determine the status of bleeding in patients 24 h later. The patients in the control group were po administered with bayaspirin, once daily. Two groups were treated for 7 d. The scores of European Stroke Scale (ESS) and Barthel Index (BI) before and after the treatment at days 1, 3, 7, 30, and 90 were compared. Results The neurological function of patients was significantly increased in both two groups after treatment. The scores on the ESS were significantly increased in both two groups after treatment at days 3, 7, 30, and 90 (P<0.05); After the treatment, ESS scores in the treatment group showed a more obvious increase compared to the control group (P<0.05). Barthel index significantly increased in both two groups after the treatment (P<0.05). There was no significant statistical difference in the two groups after the treatment for 1 d. But Barthel index showed a significant increase after the treatment for 3, 7, 30, and 90 d in the treatment group compared to the control group (P<0.05)．Conclusions The treatment of senile patients with acute cerebral infarction using rt-PA could significantly improve the neurological deficits and improve the activities of daily living.