Horizontal wells with a slim hole (HW-SH), characterized by high productivity, high environmental protection, and low cost are gradually being introduced into oil and gas extraction processes in high-temperature and high-pressure formations. However, the HW-SH annulus is narrow, and the distributions of temperature and pressure in the wellbore are very different from those of conventional horizontal wells. Furthermore, the mud properties change under the influence of high temperature and pressure. In this study, a numerical model of the transient temperaturepressure coupling field in an HW-SH wellbore was developed based on high-temperature and high-pressure performance tests of mud, combined with the characteristics of a narrow annulus in HW-SH. Subsequently, the effects of the ground temperature gradient, displacement, drill pipe speed, annulus size, and joint size on the temperature-pressure coupling field were analyzed. Measured data from the HW-SH drilled in the Mahu field in China were used to validate the developed model. The results showed that the ground temperature had a significant effect on the mud density and rheological properties. As the temperature increased, the mud density decreased, and its rheological properties improved. Although pressure also has a large effect on density, it has a negligible effect on the rheological properties of the mud. The coupled temperature-pressure field model for HW-SH considering the effects of the temperature and narrow annulus can predict the annulus temperature and pressure with an accuracy of up to 97%. The ground temperature gradient has the greatest influence on the HW-SH annular temperature, larger than that of the displacement. In addition, the annular size, rotation speed of the drill pipe, and joint size have almost no influence on the annular temperature. Compared to those of conventional horizontal wells, the rotational speed, annulus size, and joint size of the HW-SH have a greater impact on the annulus pressure.