目的:探讨多次发作的梗死前心绞痛能否减弱预处理对临床患者的心肌保护作用,为明确临床预处理耐受时间窗提供理论依据。方法:将2002～2005年急诊介入治疗的急性心肌梗死患者分为3组:组1(无心绞痛,55例)、组2(48h内1～4次心绞痛,29例)和组3(48h内4次以上心绞痛,25例)。统计患者的一般临床情况、院内预后指标(院内死亡、充血性心力衰竭/休克、复合终点等),测量心肌梗死后1周的左室射血分数,肌酸激酶和肌酸激酶同工酶的曲线下面积反映患者的心肌梗死面积。结果:各组的一般临床资料无差别。组2和组3的心肌梗死面积均低于组1(P<0.01),组2和组3间并无差别。组2的复合终点事件发生率低于组1(P=0.03),组3数值低于组1,但差异尚无统计学意义(P=0.05)。左室射血分数和其余院内预后终点各组间无差别。结论:多次梗死前心绞痛并不影响预处理的心肌保护作用。 Objective: To investigate whether multiple episodes of pre-infarction angina pectoris can weaken the protective effect of pretreatment on clinical patients and provide a theoretical basis for defining the time window of clinical pretreatment tolerance. Methods: Patients with acute myocardial infarction who underwent emergency intervention from 2002 to 2005 were divided into three groups: group 1 (no angina pectoris, 55 cases), group 2 (1 ~ 4 times angina pectoris within 48 hours, group of 29) and group 3 4 or more angina pectoris, 25 cases). The general clinical status, in-hospital prognostic indicators (nosocomial death, congestive heart failure / shock, composite end point, etc.) were recorded. Left ventricular ejection fraction (LVEF), creatine kinase and creatine kinase isoenzyme The area under the curve reflects the patient’s myocardial infarct size. Results: The general clinical data of each group had no difference. Myocardial infarct size was lower in group 2 and group 3 than in group 1 (P <0.01), and there was no difference between group 2 and group 3. The composite endpoint rate in group 2 was lower than in group 1 (P = 0.03), and in group 3 was lower than in group 1, but the difference was not statistically significant (P = .05). Left ventricular ejection fraction and the prognosis of the remaining hospital nosocomial differences between groups. Conclusions: Multiple pre-infarction angina does not affect preconditioning cardioprotection.