Objective To investigate the effects of enteral nutrition via the nasojejunal and nasogastric feeding on stroke-associated pneumonia (SAP) and other complications in patients with severe acute stroke.Methods A total of 60 patients with severe acute stroke who needed tube feeding were randomized to either a nasojejunal tube group or a nasaogastric tube group for enteral nutrition support.The occurrence of SAP,diarrhea,vomiting,and gastrointestinal bleeding within 2 weeks were observed.The nutrition indices (total protein,prealbumin,and hemoglobin) before and at day 7 and 14 after the tube placement were documented and compared.Results There were 30 patients in the nasojejunal tube group and the nasaogastric rube group,respectively.There were no significant difference in demographic and baseline clinical data between the 2 groups.The incidence of SAP (43.3％ vs.70.0％;x2 =4.340,P=0.037),vomiting (13.3％ vs.43.3％;x2 =6.648,P =0.010),and hyponatremia (6.7％ vs.40.0％;x2 =4.022,P =0.045) in the nasojejunal rube group were significant lower than those in the nasogastric rube group,however,there was no significant differences in the incidences of diarrhea and gastrointestinal bleeding.Compared with before indwelling tube,there were no significant difference in the concentrations of total plasma protein and prealbumin at day 14 after indwelling tube in the nasojejunal tube group,but the concentration of hemoglobin were decreased significantly (P =0.001);compared with before indwelling tube,the concentrations of the total plasma protein (P =0.001),prealbumin (P =0.036),and hemoglobin (P =0.001) at day 14 after indwelling tube in the nasogastric rube group were significantly decreased.Conclusions Nasojejunal nutrition may effectively prevent SAP,volmiting,and hyponatremia in patients with severe acute stroke,and contributes to maintain the nutritional status.