Objective To investigate the application of early enteral nutrition in patients with severe head injury after decompressive craniectomy.Methods A total of 57 patients with severe head injury were admitted to our hospital from January 2013 to June 2014. They were divided into early enteral nutrition group and early parenteral nutrition group after decompressive craniectomy. And after 7 days of treatment, levels of albumin and prealbumin, infectious complications in the intensive care unit (ICU), and mortality at 28 days were compared between the two groups.Results There were no significant differences in levels of serum albumin (t= 1.178, P=0.101) and prealbumin (t=0.438, P=0.648), the synthesis of nutrition for patients, infection rate (χ² = 0.292, P = 0.589), and mortality at 28 days (χ² = 0.888, P= 0.273) between the two groups. But in the early enteral nutrition group, the patients with grade I-II acute gastrointestinal injury (AGI) had a significantly higher prealbumin level (t=2.37, P=0.025), a significantly lower infection rate in the ICU (χ² = 7.636, P=0.06), and a significantly lower mortality at 28 days (χ² = 4.667, P= 0.031), as compared with those with grade III-IV AGI.Conclusions The patients with severe head injury should be grouped according to the grade of AGI after decompressive craniectomy, and then the patients with grade I-II AGI should be given early enteral nutrition as early as possible.