Objective:To observe the effects of combined acupuncture-drug anesthesia on the anesthesia tolerance and postoperative psychonosema in artificial femoral head replacement of elderly patients. Methods80 elderly patients with femoral neck fracture were randomly divided into the treatment group and control group,40 cases in each group. The control group was treated with minimally invasive artificial femoral head replacement and conventional drug anesthesia,the treatment group was treated with minimally invasive artificial femoral head replacement and combined acupuncture-drug anesthesia. The anesthetic dosage and the level of adrenocorticotropic hormone (cortisol) in peripheral blood were observed during operation,as well as the heart rate and blood pressure at different timepoints and the incidence of postoperative psychonosema. After one-year follow-up,the harris scores on hip joint function were observed.  Results:①During operation,there were statistically significant differences on the dosages of fentanyl and propofol between the two groups,and the dosages in the treatment group were obviously less than those in the control group(P＜0.05). ②5 minutes before tracheal catheter extubation,the systolic pressure of the treatment group was obviously lower than that of the control group(P＜0.05). At the moment of tracheal catheter extubation,the heart rate and systolic pressure of the treatment group were obviously lower than those of the control group(P＜0.05). After recovery,the heart rate of the treatment group was obviously lower than that of the control group(P＜0.05). ③During operation,there was no statistically significant difference on the level of cortisol in peripheral blood between the two groups(P＞0.05). ④The incidence rates of postoperative psychonosema were 12.5% in the treatment group and 37.5% in the control group. There was statistically significant difference on the incidence rate between the two groups,and the incidence rate of the treatment group was obviously lower than that of the control group(P＜0.05). ⑤There was no statistically significant difference on the excellent rate of harris scores on hip joint function between the two groups(P＞0.05).  Conclusion:The combined acupuncture-drug anesthesia shows no increase in the stress response of elderly patients with artificial femoral head replacement,based on this,it can obviously reduce the dosage of anesthetics and the occurrence of postoperative complications(psychonosema),and improve the patients’ tolerance to anesthesia.