The Sulige gas field is a typical “three lows” (low permeability, low pressure, and low abundance) tight sandstone gas reservoir, with formation pressures often characterized by abnormally high or low pressures. The complex geological features of the reservoir further deviate from conventional understanding, impacting the effective implementation of wellbore blockage removal measures. Therefore, it is imperative to establish the wellbore blockage mechanism, prediction model, and effective prevention measures for the target area. In this study, based on field data, we first experimentally analyzed the water quality and types of blockage in the target area. Subsequently, utilizing a BP neural network model, we established a model for predicting the risk of wellbore blockage and analyzing mitigation measures in the target reservoir. The model’s prediction results, consistent with on-site actual results, demonstrate its reliability and accuracy. Experimental results show that the water quality in the target area is mainly a CaCl2 type, and the predominant scales produced are CaCO3 and BaSO4. Model calculations reveal that temperature, pressure, and ion concentration all influence scaling, with BaSO4 more influenced by pressure and CaCO3 more influenced by temperature. Under the combined effect of temperature, pressure, and ion concentration, different types of scales exhibit distinct trends in scaling quantity. Combining scaling quantity calculations with wellbore contraction ratios, it was found that when the temperature, pressure, and ion concentration are within a certain range, the wellbore contraction rate can be controlled below 4%. At this point, the wellbore scaling risk is minimal, and preventive measures against wellbore scaling can be achieved by adjusting production systems, considering practical production conditions. This study investigates the mechanism of scaling in wellbores of tight sandstone gas reservoirs and proposes a cost-effective scaling prevention measure. This approach can guide the prediction of scaling risks and the implementation of scaling prevention measures for gas wells in tight sandstone reservoirs.