Objective To study the clinical effect of different tracheal intubation in patients with severe brain injury.Methods 82 patients with severe brain injury were selected and randomly divided into observation group and control group,each group had 41 cases.The observation group was given the dexmedetomidine induction combined with surface anesthesia on the basis of endotracheal intubation,and the control group was given traditional endotracheal intubation.The effects of the two groups were compared.Results The intubation time of the observation group was (26.7 ±13.8)s,which was significantly lower than (41.6 ±17.9)s of the control group(t =4.221,P =0.000).There were no differences in cardiovascular response indices between the two groups before intubation(t =0.122,P =0.903;t =0.296,P =0.768;t =1.128,P =0.263).After 10min,HR and MAP levels were significantly lower in the observation group than those in the control group(t =3.326,P =0.0.001;t =2.354,P =0.021).In the observation group,HR,MAP after intubation were lower than before intubation(t =2.548,P =0.013;t =3.626,P =0.000),the SpO2 of the two groups was higher than that before intubation(t =30.622,P =0.000;t =38.797,P =0.000),there were no differences in HR and MAP before and after intubation in the control group(t =0.846,P =0.400;t =1.824,P =0.072).There were no differences between the two groups before intubation(t =0.183,P =0.856;t =0.000,P =1.000;t =1.132,P =0.261),CK -MB,cTnT,BNP were significantly lower than those in the control group after 12h,respectively(t =2.030,P =0.046;t =2.264,P =0.026;t =3.785,P =0.000).CK -MB, cTnT,BNP were significantly lower than the control group after intubation in the two groups(t =7.845,P =0.000;t =8.591,P =0.000;t =22.757,P =0.000;t =5.525,P =0.000;t =2.264,P =0.000;t =22.149,P =0.000).The BCS and SS scores in the observation group were significantly higher than those in the control group(t =5.739,P =0.000;t =5.264,P =0.000).Conclusion The dexmedetomidine induction combined with topical anesthesia based uplink tracheal intubation scheme has significant effect,safety is good,it is worth of clinical application.