Objective To analyze the effect of continuous intravenous infusion of esmolol on cardiac function, hemodynamics and 28-day mortality in patients with septic shock. Methods A total of 160 patients with septic shock who met the criteria in our hospital from September 2021 to October 2023 were divided into control group (n=80, routine treatment) and observation group (n=80, routine treatment + continuous 24 h intravenous infusion of esmolol injection) by random number table method. The cardiac function ［left ventricular ejection fraction (LVEF), stroke index (SVI) and cardiac output index (CI)］, hemodynamics ［mean arterial pressure (MAP), peripheral vascular resistance (SVR) and heart rate］, clinical efficacy ［mechanical ventilation time, hospitalization time, ICU stay time］, condition and prognosis ［Acute Physiology and Chronic Health Assessment Ⅱ(APACHEⅡ), Sequential Organ Failure (SOFA)］, 28-day mortality and adverse reactions (hypotension, rash, phlebitis, tachycardia) of patients with septic shock before and after resuscitation were compared between the two groups. Results A total of 8 cases were lost during the test, and 76 cases were included in the final control group and observation group. There were no statistical differences in LVEF, SVI and CI between the two groups before treatment (P>0.05). After treatment , LVEF, SVI and CI in the two groups were increased, and LVEF, SVI and CI in the observation group were significantly higher than those in the control group (P<0.05). Before treatment , there were no statistically significant differences in hemodynamic indexes between the two groups (P>0.05). After treatment, the MAP increased, SVR and the heart rate decreased, and the observation group had higher MAP and lower SVR, heart rate than the control group (P<0.05).The duration of mechanical ventilation, ICU stay and hospitalization in the observation group were shorter than those in the control group (P<0.05). No statistical differences were shown in APACHEⅡ score and SOFA score between the two groups before treatment (P>0.05). After treatment , the APACHEⅡ score and SOFA score in the two groups were decreased, and the scores of APACHEⅡ and SOFA were lower in the observation group (P<0.05). The 28-day mortality rates in the observation group and the control group were 3.95% and 11.84% respectively (P>0.05). The total incidence rate of adverse reactions during medication was 5.26% in the observation group and 2.63% in the control group (P>0.05). Conclusion Continuous intravenous infusion of esmolol can improve cardiac function and hemodynamics in patients with septic shock, and effectively relieve the disease condition of patients, but it has no significant effect on 28-day mortality