OBJECTIVE： To observe the effects of butylphthalide combined with alteplase on neural funetion and cognitive function and serological indexes as homocysteine （Hcy） in patients with acute cerebral infarction （ACI）. METHODS： Clinical information of 78 ACI patients in emergency department of our hospital during Feb. 2140-Apr. 2017 were analyzed and then divided into control group and observation group according to therapy plan， with 39 cases in each group. Both groups received conventional treatment and Aspirin enteric-coated tablets orally. Control group was given Alteplase for injection 0.9 mg/kg for verous thromblysis on the basis of conventional treatment. Observation group was additionally given Butyphthalide soft capsules 0.2 g orally， tid， on the basis of control group. Both groups were treated for consecutive 28 days. The clinical efficacies of 2 groups were observed. NIHSS and MMSE scores before treatment， 3， 7， 14 and 28 d after treatment， the levels of Hcy， NSE and 6-k-PGF1a were observed in 2 groups； the occurrence of ADR was recorded. RESULTS： After treatment， total response rate of observation group was 92.31％， which was significantly higher than 71.79％ of control group， with statistical significance （P＜0.05）. 3-28 d after treatment， NIHSS scores of 2 groups were decreased gradually and significantly lower than before treatment； MMSE scores of 2 groups were increased gradually and significantly higher than before treatment， with statistical significance （P＜0.05 or P＜0.01）. 7-28 d after treatment， NIHSS score of observation group was significantly lower than that of control group at same time， while MMSE score was significantly higher than control group， with statistical significance （P＜0.05 or P＜0.01）. After treatment， serum levels of Hcy and NSE in 2 groups were decreased significantly， and observation group was significantly lower than control group； the level of 6-k-PGF1a was increased significantly， and observation group was significantly higher than control group， with statistical significance （P＜0.05 or P＜0.01）. There was no statistical significantce  in the total incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： Butylphthalide combined with alteplase can significantly improve neurologic impairment and cognitive function of ACI patients， reduce serum levels of Hcy and NSE and increase the level of 6-k-PGF1a. Clinical efficacy of it is significantly better than alteplase alone.