Abstract：Objective To investigate the short-term efficacy and influence of hemorheology of butylphthalide combined with betahistine hydrochloride in patients with posterior circulation ischemic vertigo. Methods A total of 120 patients with posterior circulation ischemic vertigo in our hospital from November 2020 to November 2021 were selected as the research objects, and they were randomly divided into control group and observation group, with 60 cases in each group. The patients in the control group were treated with betahistine hydrochloride. And the patients in the observation group were treated with butylphthalide on the basis of the control group. The hemorheological indexes, vertigo symptom scores, short-term curative effects and incidence of adverse drug reactions were compared between the two groups after treatment. Results After treatment, the hemorheological indexes of the observation group were better than those of the control group, and the vertigo symptom scores were lower than that of the control group, and the differences between the two groups were statistically significant（t＝7.3596, 11.5229, 4.3727, 8.2758, 7.1869, all P＜0.05）; the short-term curative effect of the observation group was higher than that of the control group, and the incidence of adverse reactions was lower than that of the control group, and the differences between the two groups were statistically significant（χ2＝5.8859、8.0863，all P＜0.05）. Conclusion The use of butylphthalide combined with betahistine hydrochloride in patients with posterior circulation ischemic vertigo can improve the hemorheological indexes, relieve the symptoms of vertigo, improve the short-term curative effect, and promote the recovery of the disease, which can be popularized and applied in clinic.