Objective To explore gastrointestinal motility changes and predictors in severe neurosurgical patients. Methods A total of 151 severe neurosurgical patients were selected, and their Motility Index (MI) were monitored at the start of Enteral Nutrition (EN) by ultrasound, and they were dynamically monitored each 6 hours for continuous 5 days. The latent class growth model was conducted to analyze participants′ MI trajectories, and the predictors among different groups were analyzed by using multiple logistic regression. Results Two gastrointestinal motility trajectories were fitted: low gastrointestinal motility group (86 cases, 57.0%) and high gastrointestinal motility group (65 cases, 43.0%). Multiple logistic regression analysis showed that, use of potassium or not, use of proton pump inhibitors (PPI) or not, use of ice blankets or not and the speed of EN were the predictors of the two trajectories (all P＜0.05). Conclusion The gastrointestinal motility in severe neurosurgical patients has high and low mobility two trajectories. Those patients using potassium, PPI and ice blankets, and with EN rate >50 mL/h are more likely to suffer from gastrointestinal dysfunction. Therefore, EN should be effectively implemented in clinic based on the above predictors, so as to improve patients′ gastrointestinal motility and promote their gastrointestinal function recovery.