Objective:To study the differences of clinical effect and safety of intravenous and arterial thrombolysis of rt-PA in patients with acute ischemic stroke at different time windows. Method:120 patients with acute ischemic stroke treated from August 2012 to August 2014 in our Neurology Department were selected and randomly divided into two groups, 60 cases each group. The intravenous group took the intravenous thrombolysis of rt-PA while the arterial group took the arterial thrombolysis of rt-PA. The treatment outcomes and safety of two groups were compared. Result:The total effective rate of intravenous and arterial group was 93.33% and 90.00%(P>0.05);before treatment and after 24h of treatment, 14dNIHSS of two groups was slightly reduced, but not significantly different among groups (P>0.05); after 3m of treatment, the prognosis and adverse reactions of two groups were compared. The recanalization rate and rate of favorable prognosis of two groups were higher, but not significantly different among groups (P>0.05); the incidence rate of ICH and death rate of two groups were lower, but not different among groups (P>0.05).Conclusion:The short-term and long-term therapy has a favorable prognosis and recanalization rate. The intravenous and arterial thrombolysis of rt-PA for acute ischemic stroke has a good effect and similar adverse reactions in clinical practices. It has a higher value of clinical promotion.%目的：研究急性缺血性脑卒中患者不同时间窗阿替普酶（rt-PA）进行静脉溶栓和动脉溶栓治疗的临床效果和安全性的差异。方法：临床纳入120例我院2012年8月～2014年8月期间神经内科收治的急性缺血性脑卒中患者，将所有患者按随机抽样法分为两组,各60例。其中使用阿替普酶静脉溶栓治疗的作为静脉溶栓组，使用阿替普酶动脉溶栓治疗的作为动脉溶栓组，对比两组患者治疗结果以及组间安全性差异等。结果：静脉溶栓组治疗总有效率为93.33%，动脉溶栓组治疗总有效率为90.00%，P>0.05；两组患者治疗前、治疗后24h、14dNIHSS评分比较结果显示，两组患者评分具有一定程度下降，但两组间比较无显著差异，P>0.05；治疗后3个月两组患者预后情况、不良反应发生情况比较，两组再通率、预后良好率均较高，组间比较无差异（P>0.05）；两组ICH发生率、死亡率均较低，组间比较无差异（P>0.05）。结论：短期治疗与长期治疗均有良好预后效果及再通率，临床使用阿替普酶进行静脉溶栓和动脉溶栓治疗急性缺血性脑卒中效果良好，不良反应相似，临床推广价值高。
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