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【目的】探讨阿替普酶静脉溶栓治疗起病4．5h以内的心源性脑栓塞的疗效及安全性。【方法】根据是否实行了静脉溶栓，将70例起病4．5 h内的心源性脑栓塞患者分为溶栓组和对照组，溶栓组患者使用重组组织型纤溶酶原激活物（rt‐PA ）静脉溶栓、24 h后给予华法林抗凝，对照组患者先后使用低分子肝素、华法林进行抗凝治疗。对患者入院时及治疗24 h后神经功能缺损评分（NIHSS）、出血发生率、治疗后3个月时的日常生活能力评分（ADL ）进行比较分析。【结果】溶栓组患者较对照组患者疗效好（ P ＝0．021），两组出血并发症的风险无明显差异（P ＝0．073）。【结论】阿替普酶静脉溶栓治疗起病4．5h内心源性脑栓塞安全有效。“,”Objective]To explore the efficacy and safety of intravenous thrombolysis with alteplase in pa‐tients of cardiogenic cerebral embolism in 4 .5 hours .[Methods]A total of 70 cardiogenic cerebral embolism patients were assigned into thrombolysis and comparison groups .The thrombolysis group received tissue plas‐minogen activator plus warfarin for anticoagulation while the comparison group had low weight heparin and warfarin for anticoagulation .The efficacies at 24 h and 3 months post‐thrombolysis were evaluated according to the U .S .National Institutes of Health Stroke Scale (NHISS) .And the incidence of hemorrhage and ADL scale (Barthel index) after 3 months were used to assess the extent of neurological function improvement and prognosis .[Results]The extent of neurological function improvement and prognosis of the thrombolysis group was better than that of the comparison group ( P =0 .021) .And the incidence of hemorrhage had no inter‐group statistical significance ( P =0 .073) .[Conclusion]Intravenous thrombolysis with alteplase in patients of cardiogenic cerebral embolism within 4 .5 hours is both efficacious and safe .