With the increasing complexity of the industrial production process, the transmission medium of the hydraulic turbine is no longer satisfied, and the gas-liquid two-phase mixed medium has to be considered. The presence of gas in the transmission medium will alters the internal flow structure of the hydraulic turbine and affect its operational stability. Therefore, for the purpose of clarifying the influence of inlet gas content on the internal flow of PAT, the unsteady flow of the PAT is simulated in this paper using numerical simulation. Based on the numerical simulation results, the influence of inlet gas content on the internal flow characteristics, characteristics of pressure fluctuation in impeller and volute, and vortex evolution of flow field are analyzed. The accumulation of gas phase leads to the emergence of vortices, and regions with low pressure values appear at the vortex generation. The major factor of the periodic variation of pressure fluctuation between volute and cut-water is the dynamic and static interference of impeller. The increase of gas content causes more flow disorder in the cut-water region and the volute contraction section. Since the gas in the flow channel is predominantly on the suction side of blades, the flow field on the suction side is more complex than that on the pressure side, and the amplitude of pressure fluctuation increases appropriately. The vortex structure is mainly distributed on balance hole, inlet area of impeller and suction side of blade. As the blade rotates, there are new shedding and growth of vortices, and finally attached to the volute wall. Increasing gas content enhances the influence of blade rotation on the vortex evolution characteristics in the volute and impeller.