关于心室复极顺序的错误表述——浅谈心室除复极过程与QRS-T同向机制

About the incorrect description of ventricular repolarization order: discussion on ventricular depolarization and repolarization process,and direction consistency mechanism of QRS-T

传统观点认为QRS-T同向是由于"先除极的地方后复极",这是除、复极概念上的混淆,是把3相当成了复极的全部,把2相当成了除极的延续,把复极进程的差异归于外因,而忽略了心室肌本身在细胞电生理特点上的巨大差异。实际上,先除极的地方必然先复极,但后除极的地方复极更快、结束更早,使整个心室的膜电位梯度指向外膜,故QRS向量与T向量大致同向。

In traditional opinion,the direction consistency of QRS-T is resulted from the fact that the location depolarized first is repolarized after. It confuses the concepts of depolarization and repolarization,in which 3 phases are mistakenly regarded as the whole of repolarization,2 phases are taken as the continuation of depolarization,and the variation of repolarization process is attributed to external causes without noticing the huge difference of electrophysiologic features in ventricular myocytes. Actually,where is depolarized first is necessarily repolarized first,but where is depolarized after is repolarized faster and finishes earlier,which makes membrane potential gradient of the whole ventricle points to outer membrane. Therefore,the vectors of QRS and T orient to almost the same direction.