OBJECTIVE： To observe clinical efficacy of urinary kallidinogenase in the treatment of acute cerebral watershed infarct （WSI）. METHODS： 128 patients with WSI were randomly divided into control group and treatment group， each of the 64 cases. Control group was given Shuxuening 15 ml added into 0.9％ Sodium chloride 250 ml， ivgtt， qd； treatment group received urinary kallidinogenase 0.15 PNA added into 0.9％ Sodium chloride 100 ml， ivgtt， qd. Both groups were treated for consecutive 14 days. Neurologic impairment score （NIHSS） and clinical efficacy were observed in 2 groups before treatment and 3， 7 and 14 days after treatment. The blood specimens were collected after 7 and 14 days treatment， to determine serum levels of TCC. RESULTS： After treatment， NIHSS and total effective rate of treatment group were significantly higher than those of control group， with statistical significance （P＜0.01）. There was no statistical significance in TCC between 2 groups before treatment （P＞0.05）； 7 days after treatment， TCC level of 2 groups increased significantly， to 14 days， and a declive； the treatment group was higher than the control group， with statistical significance （P＜0.05）. CONCLUSIONS： Urinary kallidinogenase can improve clinical efficacy of WSI significantly， and promote neurologic impairment symptom and TCC levels.