Objective To investigate the effect and prognosis of intravenous thrombolysis with alteplase for acute cerebral infarction（ACI）. Methods The clinical data of 107 patients with ACI admitted to a hospital in Jiyuan from March 2016 to March 2019 were retrospectively analyzed and divided into a study group（n=57） and a control group（n=50） according to the treatment method. The control group was treated with conventional thrombolysis and the study group was treated with intravenous thrombolysis with aprotinin

and the clinical efficacy

improvement of early thrombolytic symptoms and occurrence of adverse reactions in the 2 groups were compared

and the factors influencing the prognosis of patients were analyzed by multivariate logistic regression. Results The NIHSS scores were lower in the study group than in the control group at 1 week and 1 month after treatment

and the Barthel Index（BI） was higher in the study group than in the control group

and the differences were statistically significant（P<0.05）. The total effective rate of treatment for patients in the study group was 98.25%

which was higher than that of 82.00% in the control group

and the difference was statistically significant（χ~2=6.490

P=0.011）. The incidence of adverse reactions in patients in the study group was 3.51%

which was lower than that of 18.00% in the control group

and the difference was statistically significant（χ~2=6.064

P=0.014）. The differences were statistically significant（P<0.05） when comparing the age

nutritional status

pre-treatment NIHSS score

and thrombolytic treatment method in patients with good prognosis to those with poor prognosis. The results of multifactorial analysis showed that poor nutritional status

pretreatment NIHSS score ≥16

and conventional thrombolytic treatment were risk factors affecting the prognosis of patients with ACI（P<0.05）. Conclusion The clinical efficacy of intravenous thrombolysis with alteplase in ACI patients is significant

and there are many risk factors affecting the prognosis of ACI patients

and reasonable measures should be used to intervene in high-risk patients with combined risk factors to improve the prognosis.