目的：探讨替奈普酶（tenecteplase，TNK）与阿替普酶（recombinant tissue plasminogen activator，rt-PA） 在大血管闭塞急性缺血性卒中（large vessel occlusion，LVO）患者桥接治疗中的疗效及安全性。方法：回顾性 收集2022年9月至2024年9月在徐州市中心医院接受桥接治疗的LVO患者104例的基线数据和临床资料， 根据静脉溶栓药的不同，分为TNK组（49例）与rt-PA组（55例）。统计分析2组患者的基线数据、主要及次要 疗效指标、安全性指标。主要疗效指标指90 d的改良Rankin量表（modified Rankin scale，mRS）评分（mRS≤ 2分为预后良好，mRS＞2分为预后不良），次要疗效指标指术后血管再灌注率、早期神经功能改善发生率。 安全性指标包括90 d死亡率、症状性颅内出血发生率、任何部位出血发生率。根据90 d mRS评分的不同，分 为预后良好组（44例）和预后不良组（60例），采用单因素和多因素logistic回归分析筛选影响LVO患者桥接 治疗预后的因素。结果：2组患者的术后血管再灌注率、早期神经功能改善发生率、90 d死亡率、症状性颅内 出血发生率及任何部位出血发生率差异均无统计学意义（均P＞0.05）。TNK组患者的90 d预后良好发生率 高于rt-PA组（P＜0.05）。入院NIHSS评分高是LVO患者桥接治疗预后不良的独立危险因素，TNK可降低其 预后不良的风险。结论：在接受桥接治疗的LVO患者中，取栓前使用TNK与更好的功能预后相关。

To explore the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) and Tenecteplase (TNK) in bridging therapy for acute ischemic stroke patients with large vessel occlusion (LVO). Methods: Baseline data and clinical data of LVO patients (n=104) who underwent bridging treatment in Xuzhou Central Hospital from September 2022 to September 2024 were retrospectively collected. They were divided into two groups based on the difference of intravenous thrombolytic drugs, the TNK group (n=49) and the rt-PA group (n=55). The baseline data, primary and secondary efficacy indicators, and safety indicators of the two groups were statistically analyzed. The primary efficacy indicator referred to the 90 days modified Rankin scale (mRS) score (mRS≤2 was good prognosis, mRS>2 was bad prognosis), and the secondary efficacy indicator referred to the postoperative vascular reperfusion rate and the incidence of early neurological function improvement. Safety indicator included 90 days mortality, incidence of symptomatic intracranial hemorrhage, and incidence of hemorrhage from any site. According to the difference of 90 d mRS scores, patients were divided into good prognosis (n=44) and poor prognosis (n=60) groups, and the factors affecting the prognosis of bridging treatment in LVO patients were screened by using univariate and multivariate logistic regression analyses. Results: The successful reperfusion rate, incidence of early neurological function improvement, 90 days mortality rate, symptomatic intracranial hemorrhage, and hemorrhage from any site were not significantly different between the two groups (all P>0.05). The incidence of good 90 days prognosis of patients in the TNK group was higher than that in the rt-PA group (P<0.05). High NIHSS scores on upon admission was an independent risk factor for poor prognosis in LVO patients and TNK reduces the risk of poor prognosis. Conclusion: The use of TNK before thrombolysis is associated with a better functional prognosis in LVO patients with bridging.