Objective To investigate the risk factors for feeding intolerance to enteral nutrition in patients with traumatic brain injury after decompressive craniectomy.

Methods A retrospective analysis was conducted on the clinical data of 108 patients with traumatic brain injury in the First Affiliated Hospital of Nanjing Medical University from November 2022 to February 2025. All the patients underwent decompressive craniectomy and received enteral nutrition intervention postoperatively. Based on the patients' tolerance to enteral nutrition, they were divided into tolerance group and intolerance group. Univariate and multivariate Logistic regression analyses were used to identify the risk factors for feeding intolerance to enteral nutrition.

Results Among the 108 patients with traumatic brain injury after decompressive craniectomy, 32 cases had feeding intolerance to enteral nutrition, with an incidence rate of 29.63%. Univariate analysis showed that there were significant differences between thetolerance group and the intolerance group in terms of mechanical ventilation, use of acid suppressants, combined use of antibiotics, hypoproteinemia, use of vasoactive drugs, oral potassium supplements, the Glasgow Coma Scale(GCS) score, the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and the Nutritional Risk Screening-2002 (NRS-2002) score (P < 0.05). Logistic regression analysis revealed that mechanical ventilation, use of acid suppressants, combined use of antibiotics, hypoproteinemia, use of vasoactive drugs, oral potassium supplements, GCS score of 3 to 5, an APACHE Ⅱ score ≥ 20, and an NRS-2002 score ≥ 3 were independent risk factorsfor feeding intolerance to enteral nutrition in patients with traumatic brain injury after surgery (P < 0.05).

Conclusion The incidence of feeding intolerance to enteral nutrition is relatively high in patients with traumatic brain injury after decompressive craniectomy, which is mainly associated with risk factors such as mechanical ventilation, use of acid suppressants, combined use of antibiotics, hypoproteinemia, use of vasoactive drugs, oral potassium supplements, the GCS score, the APACHE Ⅱ score, and the NRS-2002 score.