Single-pressure and ultrasonic action have their own unique advantages in the treatment of metal melts. When the two are combined into a composite field, the advantages of a single physical field can be fully utilized. So, the cavitation and acoustic streaming effects characteristics of an Al-5.0Cu alloy treated under different coupling process parameters, related to applied extrusion pressure and ultrasonic vibration, were analyzed by combining numerical simulation and experimental verification. The simulation results were experimentally verified by quantitative analysis of the microstructure, the melt, and its macro characteristics. The results show that the closing time t decreases with an increase in the extrusion pressure. In addition, when the ultrasonic power and extrusion force are increased simultaneously (100 MPa and 1 kW), the average grain size and the proportion of columnar grains reach the ideal effect. The influence of pressure parameters is greater, which will also lead to an increase in the proportion of columnar crystals. By optimizing the parameters, the grain size can be further reduced, the proportion of columnar crystal structure can be reduced, and fine and uniform equiaxed crystal structures can be easily obtained.