目的 觀察阿替普酶治療老年患者急性腦梗死的臨床療效和安全性。方法 2011年6月—2013年6月在天津市第一中心醫(yī)院住院的老年急性腦梗死患者80例隨機(jī)分為治療組（40例）和對(duì)照組（40例）。治療組給予阿替普酶0.9 mg/kg，總劑量的10%靜脈推注，剩余劑量在隨后60 min內(nèi)持續(xù)靜脈滴注，24 h后經(jīng)頭顱CT證實(shí)患者有無(wú)出血。對(duì)照組口服拜阿司匹林，300 mg/次，1次/d，兩組均持續(xù)治療7 d。在兩組患者治療前、治療后1、3 、7、30、90 d進(jìn)行歐洲卒中神經(jīng)功能缺損程度（ESS）評(píng)分和Barthel指數(shù)評(píng)分。結(jié)果 兩組治療后患者神經(jīng)功能均得到不同程度的改善，和治療前相比，兩組患者治療后3、7、30、90 d的ESS平均值均較治療前有顯著提高，治療前后差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；治療后，治療組較對(duì)照組升高更明顯，兩組差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。兩組治療后Barthel指數(shù)較治療前均明顯提高，治療前后差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；治療1 d后兩組Barthel指數(shù)差異無(wú)統(tǒng)計(jì)學(xué)意義，但治療3、7、30、90 d后治療組Barthel指數(shù)平均值明顯高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。結(jié)論 阿替普酶治療老年患者急性腦梗死能夠顯著改善進(jìn)展性腦梗死患者的神經(jīng)功能缺損癥狀，提高日常生活活動(dòng)能力，療效顯著。

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.