Objective To explore the incidence rate and influencing factors of early enteral nutrition aspiration in critically ill patients. Methods Convenience sampling was used to select critically ill patients who were admitted to the surgical intensive care unit and received early enteral nutrition therapy.The patients were tracked for aspiration-related symptoms, starting from the first day of enteral nutrition therapy,for 7 days.Multiple linear regression was used to analyze the influencing factors of aspiration in critically ill surgical patients. Results A total of 126 patients were enrolled, with 30 cases (23.81%) having aspiration.The rate of hitting calories target on the 7th day in the aspiration group were significantly lower than the non-aspiration group; the length of hospital stay, and the hospital cost in the aspiration group were significantly higher than the non-aspiration group （P＜0.01 for all）.Multiple linear regression analysis showed that APACHEⅡ score, GCS score, NUTRIC score,length of nasal feeding tube insertion, were risk factors of aspiration in critically ill surgical patients （P＜0.05，P＜0.01）. Conclusion The incidence rate of early enteral nutrition associated aspiration in critically ill patients is high, which is related to consciousness status, nutrition status, severity of disease, and length of nasal feeding tube insertion.Individualized measures should be taken to prevent aspiration in critically ill surgical patients.