OBJECTIVE： To explore the effects of Xingnaojing injection combined with modified large bone flap decompression on postoperative intracranial pressure （ICP） and serum inflammatory factors in patients with severe traumatic brain injury （STBI）. METHODS： In retrospective analysis， STBI patients were selected from Wuhan Municipal Third Hospital during May 2014-Nov. 2016， and then divided into control group and observation group according to therapy plan， with 32 cases in each group. Control group received modified large bone flap decompression and rountine postoperative infection. Observation group was given Xingnaojing injection 30 mL， once a day， after modified large bone flap decompression， for consecutive 30 d. ICP levels and GCS score were compared between 2 groups 3， 5， 7 d after surgery. The levels of serum inflammatory factors （hs-CRP， TNF-α， IL-2， IL-6） were compared before surgery and 7 d after surgery. SF-36 score were observed before surgery and one month after surgery. GOS grading and the incidence of complication were observed one month after surgery. RESULTS： There was no statistical significance in baseline information between 2 groups （P＞0.05）. Before surgery， there was no statistical significance in GCS score， serum inflammatory factor level or SF-36 score between 2 groups （P＞0.05）. GOS grading of observation group was better than that of control group after surgery （P＜0.05）. Compared with control group， the levels of ICP in observation group were decreased significantly 3， 5， 7 d after surgery （P＜0.05）， while GCS score was increased significantly （P＜0.05）； 7 d after surgery， the levels of serum inflammation factors were decreased significantly （P＜0.05）. SF-36 score was increased significantly one month after surgery （P＜0.05）， and the incidence of incisional hernia and acute encephalocele were decreased significantly （P＜0.05）； there was no statistical significance in the incidence of delayed hematoma， hydrocephalus or interstitial brain edema （P＞0.05）. CONCLUSIONS： Prognosis effect of Xingnaojing injection combined with modified large bone flap decompression may be better than modified large bone flap decompression alone in the treatment of STBI， and there is difference between them.