目的 构建心脏术后患者皮肤撕裂伤预防及分级管理方案并临床应用。 方法 以风险管理理论、分级护理理论为指导，通过查阅文献、小组讨论初步拟定心脏术后患者皮肤撕裂伤预防及分级管理方案，通过专家会议确定最终方案。采用非随机分组类实验研究方法，选取2024年9月—11月266例患者为试验组，2024年6月—8月254例患者为对照组。试验组采用预防及分级管理方案进行干预，对照组采取常规皮肤护理。比较两组患者皮肤撕裂伤发生率、皮肤撕裂伤严重程度、皮肤护理费用、皮肤愈合时间，护士皮肤撕裂伤相关知识理论及操作考核分数。 结果 试验组皮肤撕裂伤发生率、严重程度，伤口愈合时间、护理费用均低于对照组（P<0.05），护士对皮肤撕裂伤风险评估及时率、准确率、护理措施落实率，理论知识及操作技能考核分数均有所提高（P<0.05）。 结论 心脏术后患者皮肤撕裂伤预防及分级管理方案科学、可行，可降低皮肤撕裂伤发生率及严重程度，减轻护理工作量，减少皮肤护理费用；提高护士对皮肤撕裂伤认知和管理能力，实现了皮肤撕裂伤预见性风险护理。

Objective To establish and implement a skin tear prevention and graded management plan for post-cardiac surgery patients. Methods Based on risk management theory and hierarchical nursing theory，an initial skin tear prevention and graded management plan for post-cardiac surgery patients was drafted through literature review and panel discussions，followed by finalization via an expert consensus meeting. Using a non-randomized controlled trial design，266 patients（September-November 2024） were allocated to the experimental group，while 254 patients（June-August 2024） were enrolled in the control group. The experimental group received a prevention and grading management plan，while the control group received routine skin care. A comparison was made between the two groups regarding skin tear incidence，severity，skincare costs，healing time，and nurses’ theoretical and practical assessment scores on skin tear management. Results The experimental group had significantly lower skin tear incidence，severity，healing time，and costs（P<0.05），while nurses achieved higher rates of timely/accurate risk assessment，intervention adherence，and test scores（P<0.05）. Conclusion The prevention and graded management plan for skin tears in postoperative cardiac patients is scientific and feasible. It can reduce the incidence and severity of skin tears，decrease nursing workload，lower skin care costs，and enhance nurses’ awareness and management capabilities regarding skin tears，achieving predictive risk-based nursing for skin tears.