背景：台灣大腸癌發生率持續偏高，隨篩檢政策擴大，接受鎮靜腸胃道內視鏡檢查之需求亦隨之增加。肥胖病人因呼吸生理特性與上呼吸道解剖結構改變，於鎮靜過程中較易發生低血氧與呼吸不良。高流量鼻導管可提供高流速加溫加濕氧氣，具穩定吸入氧濃度、沖洗鼻咽解剖死腔及產生低度呼氣末正壓效應等多重生理機制，有助於改善肥胖病人於鎮靜腸胃道內視鏡檢查期間之氧合穩定性與呼吸安全性。
研究目的：比較高流量鼻導管與傳統鼻導管於肥胖病人接受鎮靜腸胃道內視鏡檢查期間，在氧合狀態、呼吸不良、非計畫性呼吸道介入、氧療耗材費用及檢查時間之差異。
研究方法：本研究採隨機對照試驗設計，於台灣南部某醫學中心內視鏡檢查室進行收案。納入身體質量指數大於等於27 kg/m²、美國麻醉醫師學會麻醉風險分級第I至第III級，且預計接受propofol鎮靜腸胃道內視鏡檢查之病人共74位，隨機分派至實驗組36位與對照組38位。實驗組使用高流量鼻導管供氧，流速設定為40至60 L/min、吸入氧濃度40%、氣體加熱加濕至37°C；對照組使用傳統鼻導管供氧，流速4 L/min、預估吸入氧濃度約36%。統計方法依資料性質分別採描述性統計、卡方檢定或Fisher精確檢定及Mann–Whitney U檢定。
研究結果：實驗組之最低血氧飽和度顯著高於對照組（p < 0.001）；低血氧（p = 0.002）、輕微氧合不足（p < 0.001）、打呼（p < 0.001）之發生率均顯著低於對照組。非計畫性呼吸道介入方面，實驗組接受抬下顎（p < 0.001）、增加氧氣流量（p = 0.002）及放置口咽通氣管（p < 0.001）之發生率均顯著低於對照組。二組檢查時間無顯著差異（p = 0.454），但實驗組氧療耗材費用顯著高於對照組（p < 0.001）。
結論：高流量鼻導管可提升肥胖病人於鎮靜腸胃道內視鏡檢查期間之氧合穩定性，並降低部分呼吸不良與非計畫性呼吸道介入之發生率，且未延長檢查時間。研究結果支持高流量鼻導管作為肥胖病人接受鎮靜腸胃道內視鏡檢查期間之有效預防性氧療策略，並可作為台灣臨床照護指引修訂與健保給付政策評估之本土實證參考。

Obese patients undergoing propofol-sedated gastrointestinal endoscopy are at increased risk of hypoxemia because of altered respiratory physiology. This randomized controlled trial aimed to compare the effects of high-flow nasal cannula (HFNC) and conventional nasal cannula on oxygenation, respiratory adverse events, unplanned airway interventions, oxygen therapy cost, and procedure time. A total of 74 patients with a body mass index ≥27 kg/m² and American Society of Anesthesiologists physical status I–III were randomly assigned to the HFNC group (n = 36) or the conventional nasal cannula group (n = 38). The HFNC group received oxygen at 40–60 L/min with an inspired oxygen fraction of 40%, whereas the control group received oxygen at 4 L/min. Data were analyzed using descriptive statistics, chi-square or Fisher’s exact tests, and Mann–Whitney U tests. Compared with the control group, the HFNC group had significantly higher lowest oxygen saturation and significantly lower incidences of hypoxemia, mild desaturation, snoring, jaw thrust, increased oxygen flow, and oropharyngeal airway insertion (all p < .05). Procedure time did not differ significantly between groups, whereas oxygen therapy cost was significantly higher in the HFNC group (p < .001). HFNC improved oxygenation and reduced respiratory adverse events and unplanned airway interventions without prolonging procedure time, supporting its use as an effective preventive oxygen therapy strategy for obese patients undergoing sedated gastrointestinal endoscopy

張秀吟、毛玉婷（2021）．以系統性回顧比較經鼻高流量氧氣與傳統氧氣治療於急性呼吸衰竭病人之成效．澄清醫護管理雜誌，17（3），51–57。
陳宜宣、郭昭宏、吳登強、黃建民、郭富珍（2023）．智能化大腸鏡衛教提升檢查品質之研究．健康促進研究與實務，6（1&2），28–40。https://doi.org/10.29442/HPRP.202312_6(1_2).0004
衛生福利部（2024）．專科護理師於醫師監督下執行醫療業務辦法．全國法規資料庫。https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020185
衛生福利部（無日期）．護理人員法第24條．全國法規資料庫。https://law.moj.gov.tw/LawClass/LawSingle.aspx?pcode=L0020166&flno=24
衛生福利部中央健康保險署（2023）．全民健康保險醫療服務給付項目及支付標準。https://www.nhi.gov.tw/ch/lp-3778-1.html
衛生福利部國民健康署（2022）．成人肥胖防治實證指引（第二版）。https://www.hpa.gov.tw/Pages/EBook.aspx?nodeid=1788
衛生福利部國民健康署（2024）．公布111年國人癌症登記資料分析結果，五癌篩檢為健康加值。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=4809&pid=18699
衛生福利部國民健康署（2025a）．113年國人死因統計結果。https://www.mohw.gov.tw/cp-16-82775-1.html
衛生福利部國民健康署（2025b）．健康台灣–擴展腸癌防護網「腸」常篩檢護健康。https://www.mohw.gov.tw/cp-7183-81256-1.html
衛生福利部國民健康署癌症防治組（2023）．每31分鐘14秒就有1名國人罹患大腸癌定期篩檢減少29%晚期大腸癌發生率。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=4705&pid=16548&sid=16550
Al-Husinat, L., Jouryyeh, B., Rawashdeh, A., Alenaizat, A., Abushehab, M., Amir, M. W., Al Modanat, Z., Battaglini, D., & Cinnella, G. (2023). High-flow oxygen therapy in the perioperative setting and procedural sedation: A review of current evidence. Journal of Clinical Medicine, 12(20), 6685. https://doi.org/10.3390/jcm12206685
Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., Fiadjoe, J. E., Greif, R., Klock, P. A., Mercier, D., Myatra, S. N., O’Sullivan, E. P., Rosenblatt, W. H., Sorbello, M., & Tung, A. (2022). 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology, 136(1), 31–81. https://doi.org/10.1097/ALN.0000000000004002
ASGE Standards of Practice Committee, Early, D. S., Lightdale, J. R., Vargo, J. J., Acosta, R. D., Chandrasekhara, V., Chathadi, K. V., Evans, J. A., Fisher, D. A., Fonkalsrud, L., Hwang, J. H., Khashab, M. A., Muthusamy, V. R., Pasha, S. F., Saltzman, J. R., Shergill, A. K., Cash, B. D., & DeWitt, J. M. (2018). Guidelines for sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy, 87(2), 327–337. https://doi.org/10.1016/j.gie.2017.07.018
Carron, M., Tamburini, E., Fakhr, B. S., De Cassai, A., Linassi, F., & Navalesi, P. (2022). High-flow nasal oxygenation during gastrointestinal endoscopy: Systematic review and meta-analysis. BJA Open, 4, 100098. https://doi.org/10.1016/j.bjao.2022.100098
Ceban, F., Abayomi, N., Saripella, A., Ariaratnam, J., Katsnelson, G., Yan, E., Englesakis, M., Gan, T. J., Joshi, G. P., & Chung, F. (2025). Adverse events in patients with obstructive sleep apnea undergoing procedural sedation in ambulatory settings: An updated systematic review and meta-analysis. Sleep Medicine Reviews, 80, 102029. https://doi.org/10.1016/j.smrv.2024.102029
Colaianni-Alfonso, N., Herrera, F., Flores, D., Deana, C., Vapireva, M., Biasucci, D. G., Maggiore, S. M., & Vetrugno, L. (2025). Physiological effects and clinical evidence of high-flow nasal cannula during acute exacerbation in COPD patients: A narrative review. Journal of Intensive Medicine, 5(2), 127–133. https://doi.org/10.1016/j.jointm.2024.10.005
Couture, E. J., Carrier-Boucher, A., Provencher, S., Tanoubi, I., Marceau, S., & Bussières, J. S. (2023). Effect of reverse Trendelenburg position and positive pressure ventilation on safe non-hypoxic apnea period in obese, a randomized-control trial. BMC Anesthesiology, 23, 198. https://doi.org/10.1186/s12871-023-02128-7
Duprez, F., de Terwangne, C., Bellemans, V., Poncin, W., Reychler, G., Sorgente, A., Cuvelier, G., Mashayekhi, S., & Wittebole, X. (2022). High-flow nasal cannula therapy, factors affecting effective inspired oxygen fraction: An experimental adult bench model. Journal of Clinical Monitoring and Computing, 36(5), 1441–1448. https://doi.org/10.1007/s10877-021-00784-z
Enestvedt, B. K., Eisen, G. M., Holub, J., & Lieberman, D. A. (2013). Is the American Society of Anesthesiologists classification useful in risk stratifying patients for endoscopic procedures? Gastrointestinal Endoscopy, 77(3), 464–471. https://doi.org/10.1016/j.gie.2012.11.039
Ergan, B., & Ergün, B. (2025). A novel approach to high-flow nasal oxygen delivery: Physiological and clinical perspectives on asymmetrical cannulas. Thoracic Research and Practice, 26(6), 374–379. https://doi.org/10.4274/ThoracResPract.2025.2025-3-2
Ferlitsch, M., Hassan, C., Bisschops, R., Bhandari, P., Dinis-Ribeiro, M., Risio, M., Paspatis, G. A., Moss, A., Libânio, D., Lorenzo-Zúñiga, V., Voiosu, A. M., Rutter, M. D., Pellisé, M., Moons, L. M. G., Probst, A., Awadie, H., Amato, A., Takeuchi, Y., Repici, A., … Bourke, M. J. (2024). Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline–update 2024. Endoscopy, 56(7), 516–545. https://doi.org/10.1055/a-2304-3219
Fisher & Paykel Healthcare. (2022). Airvo™ 2 nasal high flow/HFNC system [2–60 L/min]. https://www.fphcare.com/us/hospital/adult-respiratory/optiflow/airvo-2-system/
Frat, J. P., & Le Pape, S. (2025). High-flow nasal oxygen is the reference treatment in acute hypoxemic respiratory failure: Pro. Journal of Intensive Medicine, 5(3), 222–229. https://doi.org/10.1016/j.jointm.2024.12.003
Jirapinyo, P., & Thompson, C. C. (2016). Sedation challenges: Obesity and sleep apnea. Gastrointestinal Endoscopy Clinics of North America, 26(3), 527–537. https://doi.org/10.1016/j.giec.2016.03.001
Katov, L., Dupree, C., Teumer, Y., Buss, A., Diofano, F., Bothner, C., Öchsner, W., Rottbauer, W., & Weinmann-Emhardt, K. (2026). Impact of body weight on sedation-related outcomes in complex electrophysiological interventions. Healthcare, 14(4), 517. https://doi.org/10.3390/healthcare14040517
Kaur, R., Ashraf, T., Bhatti, S., Nimri, F. M., & Kutait, A. (2020). Assessing respiratory complications in patients with obesity and obstructive sleep apnea undergoing a screening colonoscopy with moderate and deep sedation. Gastrointestinal Endoscopy, 91(6), AB530. https://doi.org/10.1016/j.gie.2020.03.3239
Kuo, Y. L., Chien, C. L., Ko, H. K., Lai, H. C., Lin, T. L., Lee, L. N., Chang, C. Y., Shen, H. S., & Lu, C. C. (2022). High-flow nasal cannula improves respiratory impedance evaluated by impulse oscillometry in chronic obstructive pulmonary disease patients: A randomised controlled trial. Scientific Reports, 12, 6981. https://doi.org/10.1038/s41598-022-10873-x
Li, J., Albuainain, F. A., Tan, W., Scott, J. B., Roca, O., & Mauri, T. (2023). The effects of flow settings during high-flow nasal cannula support for adult subjects: A systematic review. Critical Care, 27, 78. https://doi.org/10.1186/s13054-023-04361-5
Lian, Q., Chen, S., Cheng, X., Zhang, J., Yu, W., Zhou, R., & Su, D. (2023). Capnographic monitoring reduces hypoxia incidence in older patients undergoing gastrointestinal endoscopy under propofol sedation: Study protocol for a multicenter randomized controlled trial. Trials, 24, 192. https://doi.org/10.1186/s13063-023-07208-0
Liang, H., Hou, Y., Sun, L., Li, Q., Wei, H., & Feng, Y. (2019). Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: A randomized controlled clinical trial. BMC Anesthesiology, 19, 151. https://doi.org/10.1186/s12871-019-0821-8
Liu, H., Qu, P., Liu, Q., Xiao, F., Yang, Y., Xu, L., & Zhang, H. (2025). High-flow nasal cannula oxygen therapy: Physiological basis and clinical applications in anesthesia. Frontiers in Medicine, 12, 1661569. https://doi.org/10.3389/fmed.2025.1661569
Ma, J., & Tan, L. (2023). Research progress on prevention and treatment of hypoxemia in painless gastroscopy: A review article. Asploro Journal of Biomedical and Clinical Case Reports, 6(2), 54–63. https://doi.org/10.36502/2023/asjbccr.6291
Mandic, M., Li, H., Safizadeh, F., Niedermaier, T., Hoffmeister, M., & Brenner, H. (2023). Is the association of overweight and obesity with colorectal cancer underestimated? An umbrella review of systematic reviews and meta-analyses. European Journal of Epidemiology, 38(2), 135–144. https://doi.org/10.1007/s10654-022-00954-6
McKechnie, A., Iliff, H.A., Black, R., Ahmad, I., Chesworth, A., Chesworth, P., Davis, N., & Griffiths, C. (2025). Airway management in patients living with obesity: Best practice recommendations from the Society for Obesity and Bariatric Anaesthesia. Anaesthesia, 80(9), 1103–1114. https://doi.org/10.1111/anae.16647
Miller, R. D., Cohen, N. H., Eriksson, L. I., Fleisher, L. A., Wiener-Kronish, J. P., & Young, W. L. (Eds.). (2020). Miller’s anesthesia (9th ed.). Elsevier.
Monahan, K. J., Davies, M. M., Abulafi, M., Banerjea, A., Nicholson, B. D., Arasaradnam, R., Barker, N., Benton, S., Booth, R., Burling, D., Carten, R. V., D'Souza, N., East, J. E., Kleijnen, J., Machesney, M., Pettman, M., Pipe, J., Saker, L., Sharp, L., … Steele, R. J. C. (2022). Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): A joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG). Gut, 71(10), 1939–1962. https://doi.org/10.1136/gutjnl-2022-327985
Ng, J., Pu, L. Z. C. T., Be, K. H., Pearce, B., Lee, M., Fletcher, L., Cogan, R., Peyton, P., Vaughan, R., Efthymiou, M., & Chandran, S. (2023). High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in prolonged upper GI endoscopy: A randomized controlled trial. iGIE, 2(2), 131–138. https://doi.org/10.1016/j.igie.2023.02.002
Petkar, S., Wanjari, D., & Priya, V. (2024). A comprehensive review on high-flow nasal cannula oxygen therapy in critical care: Evidence-based insights and future directions. Cureus, 16(8), e66264. https://doi.org/10.7759/cureus.66264
Pinkham, M. I., Domanski, U., Franke, K. J., Hartmann, J., Schroeder, M., Williams, T., Nilius, G., & Tatkov, S. (2022). Effect of respiratory rate and size of cannula on pressure and dead-space clearance during nasal high flow in patients with COPD and acute respiratory failure. Journal of Applied Physiology, 132(2), 553–563. https://doi.org/10.1152/japplphysiol.00769.2021
Pozin, I. E., Zabida, A., Nadler, M., Zahavi, G., Orkin, D., & Berkenstadt, H. (2023). Respiratory complications during recovery from gastrointestinal endoscopies performed by gastroenterologists under moderate sedation. Clinical Endoscopy, 56(2), 188–193. https://doi.org/10.5946/ce.2022.033
Qi, X. R., Qi, Y. X., Zhang, K., Hao, W. W., & An, L. X. (2025). Intravenous lidocaine decreased oxygen-desaturation episodes induced by propofol-based sedation for gastrointestinal endoscopy procedures: A prospective, randomized, controlled trial. BMC Anesthesiology, 25, 27. https://doi.org/10.1186/s12871-025-02890-w
Qi, X. R., Sun, J. Y., An, L. X., Zhang, K., & Xue, F. S. (2022). Effects of intravenous lidocaine on hypoxemia induced by propofol-based sedation for gastrointestinal endoscopy procedures: Study protocol for a prospective, randomized, controlled trial. Trials, 23, 800. https://doi.org/10.1186/s13063-022-06719-6
Qiu, X., Huang, M., Wang, Q., Guo, P., Yang, X., Liu, Y., & Guan, Y. (2025). Predictive value of the STOP-Bang Questionnaire for respiratory depression risk in patients undergoing painless gastrointestinal endoscopy. Perioperative Medicine, 14, 91. https://doi.org/10.1186/s13741-025-00581-1
Riccio, C. A., Sarmiento, S., Minhajuddin, A., Nasir, D., & Fox, A. A. (2019). High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: A prospective, randomized clinical trial. Journal of Clinical Anesthesia, 54, 19–24. https://doi.org/10.1016/j.jclinane.2018.10.026
Sankar, A., Johnson, S. R., Beattie, W. S., Tait, G., & Wijeysundera, D. N. (2014). Reliability of the American Society of Anesthesiologists physical status scale in clinical practice. British Journal of Anaesthesia, 113(3), 424–432. https://doi.org/10.1093/bja/aeu100
Seyni-Boureima, R., Zhang, Z., Antoine, M. M., & Antoine-Frank, C. D. (2022). A review on the anesthetic management of obese patients undergoing surgery. BMC Anesthesiology, 22, 98. https://doi.org/10.1186/s12871-022-01579-8
Shamohammadi, H., Weaver, L., Saffaran, S., Tonelli, R., Laviola, M., Laffey, J. G., Camporota, L., Scott, T. E., Hardman, J. G., Clini, E., & Bates, D. G. (2025). Airway pressures generated by high flow nasal cannula in patients with acute hypoxemic respiratory failure: A computational study. Respiratory Research, 26, 9. https://doi.org/10.1186/s12931-025-03096-x
Sidhu, R., Turnbull, D., Haboubi, H., Leeds, J. S., Healey, C., Hebbar, S., Collins, P., Jones, W., Peerally, M. F., Brogden, S., Neilson, L. J., Nayar, M., Gath, J., Foulkes, G., Trudgill, N. J., & Penman, I. (2024). British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy. Gut, 73(2), 1–27. https://doi.org/10.1136/gutjnl-2023-330396
Sundararaman, L., & Goudra, B. (2024). Sedation for GI endoscopy in the morbidly obese: Challenges and possible solutions. Journal of Clinical Medicine, 13(16), 4635. https://doi.org/10.3390/jcm13164635
Tai, J. E., Phillips, C. L., Yee, B. J., & Grunstein, R. R. (2024). Obstructive sleep apnoea in obesity: A review. Clinical Obesity, 14(3), e12651. https://doi.org/10.1111/cob.12651
Thille, A. W., Balen, F., Carteaux, G., Chouihed, T., Frat, J. P., Girault, C., L’Her, E., Marjanovic, N., Nay, M. A., Ray, P., Reffienna, M., Retenauer, L., Roch, A., Thiery, G., & Truchot, J. (2024). Oxygen therapy and noninvasive respiratory supports in acute hypoxemic respiratory failure: A narrative review. Annals of Intensive Care, 14(1), 158. https://doi.org/10.1186/s13613-024-01389-w
Tringali, A. (2026). Sedation and anesthesia in gastrointestinal endoscopy in 2025: How, who, and why. Gastrointestinal Endoscopy, 103(3), 438–450. https://doi.org/10.1016/j.gie.2025.09.014
Wang, J. C., Peng, Y., Dai, B., Hou, H. J., Zhao, H. W., Wang, W., & Tan, W. (2024). Comparison between high-flow nasal cannula and conventional oxygen therapy in COVID-19 patients: A systematic review and meta-analysis. Therapeutic Advances in Respiratory Disease, 18, 1–13. https://doi.org/10.1177/17534666231225323
Wang, J., Wu, Q., Ding, Z., Zhang, W., Xie, K., Mao, X., & Fang, X. (2025). High-flow nasal cannula oxygenation reduces desaturation during percutaneous radiofrequency ablation under moderate sedation. Frontiers in Medicine, 12, 1517819. https://doi.org/10.3389/fmed.2025.1517819
Wang, L., Zhang, Y., Han, D., Wei, M., Zhang, J., Cheng, X., Zhang, Y., Shi, M., Song, Z., Wang, X., Zhang, X., & Su, D. (2025). Effect of high flow nasal cannula oxygenation on incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity: Multicentre randomised controlled trial. BMJ, 388, e080795. https://doi.org/10.1136/bmj-2024-080795
Wang, S., Sheng, T., Yuan, G., Li, H., Guo, X., Mai, J., Chen, C., & Luo, G. (2024). Bilevel positive airway pressure ventilation in patients susceptible to hypoxemia during procedural sedation for colonoscopy: A prospective randomized controlled study. Gastrointestinal Endoscopy, 99(6), 989–997. https://doi.org/10.1016/j.gie.2023.12.014
Wang, Y., Liu, F., Zhang, Y., Yang, X., & Wu, J. (2023). The effect of capnography on the incidence of hypoxia during sedation for EGD and colonoscopy in mildly obese patients: A randomized, controlled study. BMC Anesthesiology, 23, 188. https://doi.org/10.1186/s12871-023-02151-8
Wei, C., Ma, S., Jiang, L., Wang, J., Yuan, L., & Wang, Y. (2024). A meta-analysis of the effects of transnasal high-flow oxygen therapy in gastrointestinal endoscopy. Frontiers in Medicine, 11, 1419635. https://doi.org/10.3389/fmed.2024.1419635
Wettstein, R. B., Shelledy, D. C., & Peters, J. I. (2005). Delivered oxygen concentrations using low-flow and high-flow nasal cannulas. Respiratory Care, 50(5), 604–609. https://doi.org/10.4187/respcare.05500604
World Health Organization, Regional Office for the Western Pacific. (2000). The Asia Pacific perspective: Redefining obesity and its treatment. https://iris.who.int/handle/10665/206936
World Health Organization. (2022). Care, cleaning and disinfection of high-flow nasal cannula. World Health Organization. https://www.who.int/publications/m/item/care-cleaning-and-disinfection-of-high-flow-nasal-cannula
Zhang, Y. X., He, X. X., Chen, Y. P., & Yang, S. (2022). The effectiveness of high flow nasal cannula during sedated digestive endoscopy: A systematic review and meta analysis. European Journal of Medical Research, 27, 30. https://doi.org/10.1186/s40001-022-00661-8